Understanding gynaecological cancer with Mr Chris Barnick

Did you know over 21,000 women are diagnosed with gynaecological cancer in the UK every year?

Each day around 58 people are diagnosed with gynaecological cancer and, sadly, there are around 21 deaths per day as a result. Prognosis is greatly improved with early diagnosis, but unfortunately, lack of public awareness, embarrassment and inability to screen for certain cancers means that too often women get a late diagnosis.

So what kind of things should you look out for and is there any way to prevent certain gynaecological cancers? We spoke to Mr Chris Barnick, an Obstetrician and Gynaecologist at St John And St Elizabeth Hospital, to find out.

What are the different forms of gynaecological cancers?

Gynaecological cancer refers to cancer of the womb, ovaries, cervix, vagina or vulva. Within these organs, there are also cells and muscles which can develop cancer.

What is HPV and can it be avoided?

Smear tests look for Human Papillomavirus (HPV), so if HPV is present we would look at the cervical cells and check for abnormalities. Around 30-40% of women have HPV, but low risk strains aren’t really an issue. Higher risk HPV can lurk in the cells of the cervix, known as the transformation zone, and can develop into cancer.

High risk HPV causes cancer of the cervix and is also associated with other cancers like vaginal, rectal and oropharyngeal cancers. HPV is sexually transmitted and is very hard to avoid it if you are sexually active, barrier methods of contraception can reduce the risk of transmission.

What are the key signs and symptoms to look out for?

We’re most worried about persistent, irregular bleeding and bleeding after sex. Early stage cancers don’t cause pain but they will when more advanced.

Why is it important to get a smear test?

We have fantastic opportunities for preventing cervical cancer but it relies on people coming forward for screening and continuing to be screened. Unfortunately, the majority of people who come forwards with cancer of the cervix have not had a smear.

Testing works. It’s worth going through the slight embarrassment of having a smear test because it can prevent cancer.

Please have your smear test. If you’re sexually active, make sure you keep going for your smear tests because this is a chance to prevent this disease full stop. It would be amazing if we could get rid of it altogether.

Can you get a smear test before the age of 25 if you’re concerned?

Absolutely. You’ve got to put your foot down and say you’re worried. If a doctor has somebody who’s got irregular bleeding or bleeding after sex, they should at least examine the cervix with a speculum.

Are there any measures in place for people who find smear tests difficult, to make it less painful? People with vaginismus, for example?

Vaginismus is tricky because you can’t tell people with this condition to relax. More than anything, it’s about the doctor or nurse being nice and doing their best to put people at ease. There are also different size speculums and the GP can send for a specialist if necessary.

I’d advise all women who find it difficult to have smear tests to please tell the doctor or nurse before they start. It’s happened to me so many times and it’s only when you actually get on with it that the patient says ‘oh I’m not very good at this!’ but it’s not something to be ashamed of.

What are the treatments and prognosis for gynaecological cancers?

That would depend on the type of cancer and how advanced it is. If we look at cancer of the ovary that tends to spread very quickly – cutting it out completely is going to be tricky.

We would cut out as much as we can and then use chemotherapy. Sometimes people have chemotherapy beforehand to shrink the tumour mass, then have surgery to remove as much of the cancer as possible, and then chemotherapy again to mop up what’s left.

Cancer of the cervix spreads from where it’s growing. They can be cut out if caught early, which makes it much less likely for it to spread beyond that point. You can cure people and get amazing results.

Presenting with a later stage cancer is the exact opposite, because we can’t cut it all out if it’s spread into the bladder or bowel for example. You end up not being able to cut the cancer out, so you try to destroy it with radiotherapy and chemotherapy. For advanced cancer, you’re often looking at winning time rather than curing the cancer.

What about having kids in the future?

What we used to do in the old days with cancer of the cervix was a radical hysterectomy, after which there was no chance of having children.

Now, what we’re able to do if we catch the cancer early enough is just remove the cervix and conserve the rest of the womb so people can still go on to have biological children.

If we’re going to give people chemotherapy, they can consider preserving bits of their ovary for future use or freezing their eggs. We do our best to be the least radical we can, but we still have to fight the cancer.

Are certain women at higher risk of gynaecological cancers? 

Women who are older and have had exposure to HIV. There is a familiar component as well, especially with ovarian cancer. Some people with a strong family history of cancer, like Angelina Jolie, may choose to have a hysterectomy to remove their risk after they have their children.

Are younger women still at risk for gynaecological cancers?

They can develop cervical cancer. Cancer of the womb is more likely as you get older, because we’re looking at failure to repair genetic abnormalities. Our cells repair that faulty genetic material all the time and our immune systems get rid of those cells, but as we get older our repair systems get worse.

Can trans women get vaginal cancer?

A trans woman’s vagina is made out of the skin of the penis which is turned inside out. You’re looking at something much more hardy and less likely to be affected by HPV. It’s not impossible, but much less likely.

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