Cervical Cancer

What is Cervical Cancer?

Cervical cancer is cancer arising from the cervix. It is due to changes in the cells of the cervix which allow them to invade and spread to other parts of the body. 
The main types of cervical cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the thin, flat cells that line the cervix. Adenocarcinoma begins in cervical cells that make mucus and other fluids.

What is the Cervix?

The cervix is the lower, narrow end of the uterus also known as the 'neck of the womb'. The cervix leads from the uterus to the vagina. 

What causes Cervical Cancer?

Almost all cases of cervical cancer can be linked to long-term infection with certain types of human papillomavirus (HPV). Vaccines that protect against infection with these types of HPV can greatly reduce the risk of cervical cancer. Having a Pap smear to check for abnormal cells in the cervix or a test to check for HPV can find cells that may become cervical cancer. These cells can be treated before cancer forms. Cervical cancer can usually be cured if it is found and treated in the early stages.

Cervical Cancer Screening

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage

Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue
These changes occur more often in women who are in their 20s and 30s. Death from cervical cancer is rare in women younger than 30 years and in women of any age who have regular screenings with the Pap smear
The Pap smear is used to detect cancer and changes that may lead to cancer. (See more information on the Pap Smear here)

An HPV test may be done with or without a Pap smear to screen for cervical cancer. Screening women aged 30 and older with both the Pap test and the HPV test every 5 years finds more cervical changes that can lead to cancer than screening with the Pap smear alone. Screening with both the Pap smear and the HPV test lowers the number of cases of cervical cancer.

What are the signs of Cervical Cancer?

The early stage of cervical cancer is often free of symptoms. Some persons may report one or more of the following symptoms:

• Blood spots or light bleeding between or following periods
• Menstrual bleeding that is longer and heavier than usual
• Bleeding after intercourse, douching, or a pelvic examination
• Increased vaginal discharge
• Pain during sexual intercourse
• Bleeding after menopause
• Unexplained, persistent pelvic and/or back pain

How is Cervical Cancer Diagnosed?

Cervical cancer can be diagnosed by the doctor taking a careful history of the patient's risk factors and symptoms, doing a complete physical examination and performing a number of tests. 
Additionally, a pelvic examination will be done.  In this examination, the doctor feels a woman’s uterus, vagina, ovaries, cervix, bladder, and rectum to check for any unusual changes. A Pap test is often done at the same time. 

If the Pap test showed some abnormal cells and the HPV test is positive, then the doctor may suggest 1 or more of the following diagnostic tests:

• Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. Colposcopy can also be used to help guide a biopsy of the cervix. A special instrument called a colposcope is used. The colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body and the examination is not painful. 
• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). If the lesion is small, the doctor may remove all of it during the biopsy.

If the biopsy shows that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix

Cervical Cancer Staging

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. For cervical cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique or FIGO) is used. (Click here for more details on the staging of cervical cancer)

How is Cervical Cancer treated?

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. The treatment of cervical cancer depends on several factors, including the type and stage of cancer, possible side effects, and the woman’s preferences and overall health.

Treatment Options

Surgery -  the removal of the tumor and some surrounding healthy tissue during an operation.

Radiation therapy - the use of high-energy x-rays or other particles to destroy cancer cells.

Chemotherapy - the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide.

For more information, screening tests and treatment of Cervical Cancer, book your appointment to see a gynecologist today! 

References: Cancer.net/cervicalcancer

Menopause

What is menopause?

This is a natural phase of a woman’s life as she ages. It is normally described as the final menstrual period in which a woman is not able to bear children.

History of Menopause

Although Aristotle referred to age at menopause being 40 years, it was a  French physician Dr. Charles Négrier who coined the term menopause in 1821. Menopause is also known as the climacteric. The word menopause itself comes from the Greek, ‘men’ for month, and ‘pausis’ for pause.

Types of Menopause

There are two types of menopause. There is spontaneous or natural menopause is recognized retrospectively after 12 months of amenorrhea (no period). It occurs at an average age of 52y ears, but the age of natural menopause can vary widely from 40 to 58 years. Induced menopause refers to the cessation of menstruation that occurs after either bilateral oophorectomy or iatrogenic ablation of ovarian function (eg, by chemotherapy or pelvic radiation).

Phases of Menopause

Before menopause is called, pre-menopause. When the signs and symptoms start but there is still a period, it called peri-menopause. The time when the period stops for a year, that is called menopause and thereafter, the woman is in the post menopause phase

Common Signs & Symptoms

The symptoms that women experience are primarily related to a lowered production of the female sex hormones estrogen and progesterone. Symptoms vary widely because of the many effects that these hormones have on the female body. These may include: 

Irregular Periods

Vaginal Dryness

Hot flashes

Chills

Night sweats

Sleep problems

Mood changes

Weight gain and slowed metabolism

Dizziness
Bone Loss
Heart Palpitations
Headache
Sore Breasts
Dry hair and hair loss
Sensitive skin
Fatigue
Prolapse resulting in loss of libido and painful sexual intercourse

 Menopause Confers Increased Risk For: 

 

Depression

Heart Disease

Insomnia

Osteoporosis

Mental Illness

Skin Diseases

Hair Loss

Help – Medical Care and Other Treatment

1.     Menopause counselling, including discussion of physiologic changes, assessment of menopause-related symptoms and treatment options, review of screening recommendations, and discussion of disease risk-reduction strategies and psychosocial issues, facilitates informed decision making among midlife and older women

2.     Thorough physical examination and screening for diseases you may be at risk for.

3.      Treatment for disease that exist when assessed.

4.      Hormonal Replacement Therapy

5.     Natural Approach

Other Supportive Measures

Use of megavitamin use and prayer. Increased dietary soy (legumes, soy, tofu), isoflavone products, and other forms of phytoestrogens reduce menopause symptoms.  Acupuncture reduces hot flashes and improves sleep patterns in postmenopausal women.  Regular consumption of soy isoflavones in the diet may offer breast cancer protection if exposure occurs during breast development. Soy isoflavones also may inhibit the progression of atherosclerosis if initiated within 5 years after the onset of menopause. Exercise and stress management. Use of Black Coash and Evening Primrose can be useful.

Closing thought: Staying healthy is key. If you know what to expect, it is easier to manage.

Contributed by: Dr. Heather Fletcher, Menopause Health Educator

Abnormal Vaginal Discharge

Vaginal discharge is a substance composed of a mixture of liquid, cells and bacteria to serve to protect and lubricate the vagina. It is produced constantly by the cells of the vagina and cervix and exits the body through the vaginal opening. The quality, amount and composition of the discharge varies between individuals and may vary at different stages of sexual and reproductive development. It also varies according to the menstrual cycle and can also be an indication of imbalance or disease. 

What is normal vaginal discharge?

Normal vaginal discharge tends to be thin and watery or thick and sticky in consistency, and is usually clear or white in color. Normal discharge tends not to have an odor or cause vaginal itching or pain. There may be more discharge if you are ovulating, breastfeeding, or sexually aroused. The smell may be different if you are pregnant.

What is abnormal vaginal discharge?

Any change in the balance of normal bacteria in the vagina can affect the smell, colour, or texture of the discharge. A few of the things that can upset that balance include: 

• Antibiotic or steroid use
• Bacterial vaginosis, which is a bacterial infection that is not sexually transmitted, but more common in women who have multiple sexual partners
• Birth control pills
• Cervical Cancer
• Chlamydia or gonorrhea, which are sexually transmitted infections
• Diabetes
• Scented soaps or lotions, bubble bath
• Pelvic infection after surgery
• Pelvic inflammatory disease (PID)
• Trichomoniasis, which is a parasitic infection typically caused by having unprotected sex
• Vaginal atrophy, which is thinning and drying out of the vaginal walls during and after menopause
• Vaginitis, which is irritation in or around the vagina
• Yeast infections

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When should you check with a doctor?

• Greenish, yellowish, thick or cheesy vaginal discharge
• Strong vaginal odor
• Redness, itching, burning or irritation of your vagina or the area of skin that surrounds the vagina and urethra (vulva)
• Bleeding or spotting unrelated to your period

What are some of the questions your doctor will ask?

• When did the abnormal discharge begin?
• What colour is the discharge?
• Is there any smell?
• Do you have any itching, pain, or burning in or around the vagina?
• Do you have more than one sexual partner?
• Do you douche?

What are some of the tests that may be done?

The doctor may take swabs from the vagina, cervix and urethra for testing. Blood tests for HIV and other sexually transmitted infections may also be done. 

How can abnormal vaginal discharge be treated?

Seek medical advice if you notice any unusual discharge. How you are treated will depend on the condition that's causing the problem. For example, yeast infections are usually treated with antifungal cream, vaginal tablet (pessary) or a tablet taken by mouth. Bacterial vaginosis is treated with antibiotic pills or creams. Trichomoniasis is usually treated with the antibiotic metronidazole.

How can you prevent the development of an abnormal vaginal discharge?

• Keep the vagina clean by washing regularly with a gentle soap and warm water.
• Never use scented soaps or douches. Also avoid feminine sprays and bubble baths.
• After going to the toilet, always wipe from font to back to prevent bacteria from getting into the vagina and causing infection.
• Wear 100% cotton underwear and avoid overly tight clothing.
• Practice safe sexual practices including the use of a condom and having one faithful partner.

Have more questions about vaginal discharge? Check us out on facebook or give us a call! 

If you think you may have an abnormal vaginal discharge, book your appointment with The Obstetrics and Gynaecology Centre today to see a gynaecologist! 

Sources: https://en.wikipedia.org/wiki/Vaginal_discharge
https://www.mayoclinic.org/symptoms/vaginal-discharge/basics/causes/SYM-20050825
http://kidshealth.org/en/teens/vdischarge2.html?WT.ac=ctg

Endometriosis

What is Endometriosis?

Endometriosis  is a disorder in which tissue that normally lines the inside of the uterus — the endometrium — grows outside the uterus. It is often a painful disorder which most commonly involves the  ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

What happens in Endometriosis?

Endometrial tissue found within the uterus normally undergoes changes throughout the menstrual cycle, including thickening, breaking down and bleeding. This normally results in a menstrual period. The endometrial tissue that grows outside of the uterus behaves similarly, however this tissue has no way to exit the body and becomes trapped. This may lead to the formation of cysts (involving the ovaries) or scar tissue and adhesions (sticky bands that cause pelvic tissue and organs to stick together). Endometriosis may cause severe pain especially during periods and fertility problems.

What are the symptoms of Endometriosis?

The most common symptom of endometriosis is pelvic pain, often associated with the menstrual period. However, although most women experience cramping abdominal pain with periods, those affected by endometriosis report severe and worsening pain. 

Common signs and symptoms of endometriosis:

·        Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.

·        Pain with intercourse. Pain during or after sex is common with endometriosis.

·        Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.

·        Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).

·        Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.

·        Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of the pain is not a good indicator of the extent of the disease as some women with mild endometriosis may have severe pelvic pain while women with advanced disease may have mild symptoms. 

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

When to see the doctor

See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

If you think you may be having symptoms of endometriosis, feel free to make an appointment at TOG Centre for assessment and management. 

Credits: Mayo Foundation for Education and Research