In June last year, Wanja’s Health Diary witnessed a surgery at Kenyatta National hospital to remove the uterus of a 70 year old patient with cervical cancer stage one. The surgery known as Radical Werheims abdominal hysterectomy involved the removal of the entire uterus, the connective tissue and lymph nodes close to it, fallopian tubes, ovaries, and the upper part of the vagina.
The team was led by Dr Alfred Mokomba, a consultant obstetrician and gynaecologist and a Fellow in Gynaecology Oncology at Kenyatta National Hospital. Dr Mokomba showed us the parts affected by the cancer. Today we explore a wider field of the cancers that mainly affect women. They have loosely been described as ‘women’ cancers but the correct term is gynaecological cancers because they affect the female reproductive organ system.
These cancers include;
Cervical cancer is the most common type of cancer and statistics show that it kills seven women daily in Kenya. Ovarian cancer is difficult to detect in early stages hence the treatment should begin immediately once diagnosed at an early stage.
Dr Mokomba, a consultant obstetrician and gynaecologist and a Fellow in Gynaecology Oncology
“Cervical cancer is one of the most preventable cancers through a vaccine that is most suited for girls before they begin their sexual debut. In Kenya, the vaccine is now available in public health facilities for 10-year-old for free. This is a win!” said Dr Mokomba.
“The commonest female cancer is cervical and breast cancer with about 500, 000 cases annually,” Dr Mokomba said
He further noted that for cancer of the cancer of the breast and cervix, early diagnosis makes it easier to treat and is inexpensive. “On treatment, early stage cancer for stages one and two, surgery is the preferred treatment options whereas for stages three and four, radiotherapy is advised,” he added.
“If a sister, aunty or any other close female relative has had breast or ovarian cancer, it good to be screened regularly because these tend to run in families,” Dr Mokomba noted.
The following risk factors can also place you at a higher risk of getting the gynaecological cancers;
- Infection by Human Papilloma virus 16 & 18 places one at risk of cervical, valvular and vaginal cancer.
- Increasing age
- Having a strong family history- up to 10% of patients with uterine cancer have had a history of the disease
- Identified gene mutations
- Exposure to hormones – produced by the body or taken as medication
- Lifestyle factors such as smoking and those leading to excess body weight.
What are the symptoms of these cancers. Dr Mokomba acknowledges that the symptoms vary depending on the organ affected.
“Whereas abdominal vaginal bleeding and discharge are some of the common signs and symptoms of these gynaecological cancers, some can be specific such as pelvic pain that can occur with uterine and ovarian cancer,” Dr Mokomba noted. Other symptoms include bloating, constipation, an increased need to urinate, itchiness and soreness. Dr Mokomba was on how to handle the concerns above.
“The rule of thumb is to always have regular gynecologic exams to check for signs of disease,” Dr Mokomba said
According to the Centre of Disease Control and Prevention, there are specific symptoms that are associated with some types of gyneacologic cancers. These include;
- Abnormal vaginal bleeding or discharge is common on all gyneacologic cancers except vulvar cancer.
- Feeling full too quickly or difficulty eating, bloating, and abdominal or back pain are common only for ovarian cancer.
- Pelvic pain or pressure is common for ovarian and uterine cancers.
- More frequent or urgent need to urinate and/or constipation are common for ovarian and vaginal cancers.
- Itching, burning, pain, or tenderness of the vulva, and changes in vulva colour or skin, such as a rash, sores, or warts, are found only in vulvar cancer.
According to Dr Mokomba, cancer treatment also varies depending on the stage of the disease. ” For more advanced disease, a hysterectomy (removal of the uterus) is usually the nest option. Other options include radiation or chemotherapy which prevent the cancer from spreading further,” said Dr Mokomba.
How can you reduce the chances of getting these cancers?
Dr Mokomba notes that for some types of cancer like cervical cancer, there is a specific screening test, the pap smear or HPV test.
In other cases, screening tests that look for the disease would come in handy and in some cases, diagnosis tests are advised. These are done when a person has symptoms and the test seeks to find out, or diagnose, what is causing the symptoms.
“The HPV test looks for the virus (human papillomavirus) that can cause these cell changes whereas the pap smear test looks for pre-cancers, cell changes on the cervix that might become cervical cancer if they are not treated early enough,” Dr Mokomba said.
Another popular test that checks for cervical cancer is the Visual Inspection with Acetic acid which is aa simple and inexpensive test which can be provided by trained health personnel like nurses and clinical officers.
How do you prepare for a pap smear or HPV test?
The CDC shares a few tips;
- You should not schedule your test for a time when you are having your period
- You should not douche (rinse the vagina with water or another fluid).
- You should not use a tampon.
- You should not have sex.
- You should not use a birth control foam, cream, or jelly.
- You should not use a medicine or cream in your vagina.