I’m a women’s cancer expert – four symptoms you should never ignore

Early detection is key with all types of cancer, but delays happen because many have symptoms which are dismissed as other, benign health conditions. When it comes to gynaecological cancers such as cervical, ovarian or womb cancer, symptoms which might be normal if you have digestive problems, are getting older, or are in menopause, could actually be a sign of something serious. Dr Mary McCormack has been an oncologist specialising in gynaecological cancers for 24 years. She says despite high-profile awareness campaigns, many women still feel embarrassed or uncomfortable about seeking advice for symptoms which involve intimate parts of their body. “Symptoms such as vaginal bleeding, discharge, itching, pelvic pain or changes in sexual health can be associated with embarrassment, anxiety or stigma,” she says. “There can also be a tendency for women to normalise symptoms, particularly around menstruation, menopause or ageing, and delay seeking help as a result.” According to the charity The Eve Appeal, 60 people a day are diagnosed with one of the five gynaecological cancers – womb, ovarian, cervical, vulval and vaginal. Womb cancer is the most common gynaecological cancer in the UK, with around 10,000 women diagnosed each year. McCormack, who works as one of HCA Healthcare UK’s leaders in oncology care, says: “Fortunately, it is also one of the cancers most commonly diagnosed at an early stage.” The doctor wants to encourage more open conversations about these types of cancer so women know to seek help when they notice something that’s not normal for their body. “You know your body better than anyone else, and if something doesn’t feel right, it’s always appropriate to seek medical advice,” she says. “Early conversations can lead to earlier diagnoses, earlier treatment and, ultimately, better outcomes.” Shorts Below McCormack outlines some of the most common symptoms of these types of cancer, while also reassuring us that these symptoms can be caused by a range of issues and many women who seek advice from their GP will not have cancer. Bloating, feeling full and pain “Ovarian cancer is the sixth most common cancer in women in the UK and affects around 7,700 women each year,” says McCormack. This disease can be more difficult to diagnose because the symptoms can easily be mistaken for less serious conditions. But the key symptoms are “persistent bloating, feeling full quickly when eating, pelvic or abdominal pain, increased urinary urgency and changes in bowel habits”. Ovarian cancer is often misdiagnosed as irritable bowel syndrome (IBS) but a scan and blood test will be able to detect if you have cancer. Bleeding The most common symptom for womb (endometrial or uterine) cancer is vaginal bleeding, often after the menopause. McCormack says: “Women may also experience heavier periods, bleeding between periods or unusual vaginal discharge. Any blood loss, no matter how little, after periods have stopped, should be investigated.” Bleeding is also a symptom of cervical cancer which is most common among women aged 30-34. The UK has a good cervical cancer screening programme but it’s important to also be aware of the symptoms. These include bleeding during or after sex, bleeding between periods, bleeding after menopause (12 months after your last period), unusual vaginal discharge and pelvic pain. However, McCormack says early cervical cancer may not cause any symptoms at all which is why it’s so important to have regular smear tests. Abnormal vaginal bleeding, especially after menopause, is also a symptom of vaginal cancer. Forty per cent of this type of cancer is in people aged over 75 but it is the most rare of the five gynaecological cancers. Soreness, a lump or itching in your vulval area “Persistent itching, skin changes or lumps should never be ignored,” says McCormack. This is because they are all symptoms of vulval cancer, which is quite uncommon, with around 1,500 new cases diagnosed annually in the UK. This type of cancer may also cause ulceration, skin discolouration, a mole which has changed shape or colour, and open sores. These should all be checked immediately. A lump or swelling can also be a sign of vaginal cancer. Pelvic, back or abdominal pain Pelvic pain and lower back pain are both symptoms of vaginal and cervical cancer and less commonly ovarian cancer. This is because tumours can press on nerves, organs or pelvic tissue. If the back pain doesn’t go away or improve with rest or painkillers you should see a doctor urgently. New pain during sex can also be a sign of cervical cancer and vaginal cancer. “While some gynaecological cancers can occur in younger women, the risk generally increases with age because cells accumulate genetic changes over time,” says McCormack. But it’s important to remember that these cancers can be treated more successfully and require less intensive treatment when they’re diagnosed early. “For example, womb and cervical cancers diagnosed early are frequently curable,” says McCormack. “Ovarian cancer can be more challenging because it is usually diagnosed at a later stage, but treatment options continue to improve, and survival rates have increased significantly over recent decades.” If you are trans, non-binary or intersex you are still at risk of some gynaecological cancers if you have female reproductive organs and a vagina or vulva. And of course, there are many non-cancerous gynaecological conditions which can also have a big impact on a woman’s quality of life. These include endometriosis, fibroids, ovarian cysts, pelvic inflammatory disease, pelvic organ collapse and menopausal symptoms. “Although these conditions are not cancerous, they can cause chronic pain, heavy bleeding, fertility issues and emotional distress. Women should seek medical advice if symptoms are affecting their day-to-day lives,” says the oncologist. Can we reduce our risk of these cancers? We know that our lifestyle and habits can affect our risk of developing many types of cancer. For example, The Eve Appeal states that smoking can double your risk of developing cervical cancer. The HPV vaccine which is offered in Year 8 of school has been shown to reduce the number of cervical cancer cases by 90 per cent. McCormack says “maintaining a healthy weight is particularly important” as obesity is a significant risk factor for womb cancer and other cancers. “Regular physical activity, a balanced diet rich in fruit, vegetables and fibre and limiting alcohol consumption” can all lower your cancer risk. “Attending routine cervical screening appointments remains one of the most effective ways to prevent cervical cancer through the identification and treatment of pre-cancerous changes,” she adds. “For those with a mutation in the BRCA gene then having the fallopian tubes and the ovaries removed by the age of 40 will dramatically reduce the risk of developing ovarian cancer.” And finally, remember, you’re never wasting a doctor’s time by getting a new symptom or change examined. September is Gynaecological Cancer Awareness Month. For more information about these types of cancers go to eveappeal.org.uk or the NHS website.