Gynaecological cancer: five cancers, symptoms worth knowing, and where nutrition fits
What to be aware of, when a change deserves medical attention, and the role nutrition can play alongside cancer care…
September is Gynaecological Cancer Awareness Month. As a nutritional therapist with specialist training in cancer nutrition, there are two things I particularly want to talk about: knowing when a symptom deserves medical attention, and understanding what nutrition can and cannot do alongside cancer care.
The five
There are five gynaecological cancers: womb, ovarian, cervical, vulval and vaginal.
And I suspect that, while most of us could name ovarian and cervical cancer, considerably fewer could confidently name all five let alone some of the symptoms associated with them.
What should we be aware of?
There isn’t one single set of ‘gynae cancer symptoms’, because these are five different cancers. But there are changes worth knowing about.
Not every change or symptom means cancer. Far from it. Many of the symptoms associated with gynaecological cancers are common and have other explanations.
But knowing what is normal for you, noticing when something has changed and getting a persistent or unusual symptom checked is important.
Unusual vaginal bleeding deserves attention. That includes bleeding after sex, between periods, periods that have become unusually heavy for you, and particularly any vaginal bleeding or spotting after menopause. Changes in vaginal discharge can also warrant investigation. These can occur with womb, cervical and vaginal cancers, although there are many non-cancerous causes too.
With ovarian cancer, symptoms can include persistent or frequent bloating or a swollen tummy, pelvic or abdominal pain, feeling full quickly or losing your appetite, and needing to urinate more urgently or frequently. Speak to your GP if these symptoms are happening frequently or if symptoms you've already sought advice about persist, worsen or become more frequent. This one is tricky as so many of these symptoms can mean other things too - always worth getting things checked over as it may well be something else entirely.
Changes around the vulva or vagina. A persistent itch, lump, sore or ulcer, skin changes, unusual bleeding or discharge, or pain when urinating should not be ignored - it may feel a bit awkward to mention but medical practitioners deal with this every day and you are worth their time.
Pelvic, lower abdominal or lower-back pain and pain during sex can also occur with some gynaecological cancers. Again, these symptoms are very common and cancer is not the only possible explanation.
The important point is not to diagnose yourself from a symptom list, but to get a new, persistent or changing symptom assessed properly.
Don't forget cervical screening
Cervical screening is sometimes misunderstood as a test for cervical cancer. It isn't. It is designed to help prevent cervical cancer by testing for high-risk HPV and where appropriate, checking for cell changes that can be treated before they develop into cancer.
In England, women aged 25-64 are currently invited every five years, and everyone with a cervix should consider attending when invited. HPV vaccination can offer additional protection, but vaccination does not make cervical screening unnecessary.
For some people, cervical screening can be difficult to attend, whether because of discomfort, embarrassment, previous experiences, trauma, practical barriers or simply life getting in the way.
There is now another option beginning to become available.
In England, the NHS has started rolling out HPV self-testing at home for people who are not up to date with cervical screening. The test involves taking your own vaginal swab, rather than having a cervical sample taken by a clinician, and sending it back to be tested for high-risk HPV.
For now, self-testing is not replacing routine cervical screening. It is initially being offered to eligible people who haven't attended following previous invitations, while further evaluation looks at whether self-sampling could eventually be offered more widely.
I think this is an important development. Anything that can safely reduce some of the barriers that stop people taking part in screening has the potential to make screening more accessible.
And perhaps most importantly: if you're invited for cervical screening, don't wait for a home test on the assumption that everyone will receive one. If you normally attend cervical screening, the current advice is to continue booking your appointment as usual.
So where can nutrition come into this?
This is where I want to be very clear.
There is no food, diet or nutritional supplement that treats or cures cancer. Nor is there one special ‘anti-cancer diet’ that everyone diagnosed with cancer should follow.
Nutrition can, however, have an important supportive role.
Cancer itself and treatments such as surgery, chemotherapy and radiotherapy can affect appetite, weight, digestion, taste, energy requirements and someone's ability to eat normally. What is nutritionally appropriate can therefore look very different from one person to another and may change during treatment and recovery.
Sometimes the priority isn't making somebody's diet look conventionally ‘healthy’. It may be helping them get enough energy and protein when eating is difficult, adapting food around treatment side effects, maintaining weight or simply making eating feel manageable again.
A word about supplements
A cancer diagnosis can understandably create an enormous desire to do something. And that can make supplements, restrictive diets and confident online claims particularly seductive.
But ‘natural’ does not automatically mean harmless.
Some supplements and herbal products can interact with cancer treatments or potentially affect how well they work. It’s important to work with someone appropriately qualified before taking them during treatment; high-dose antioxidant supplements are one area of concern and a common one I see people taking a lot of when they come and see me.
So this is not a situation in which I would recommend throwing a collection of supplements at someone because they have been labelled ‘immune supporting’ or ‘anti-inflammatory’.
More isn't automatically better. Cancer nutrition deserves more care than a supplement shopping list.
What I would like people to take from this month
Know that there are five gynaecological cancers.
Become familiar with what is normal for your own body.
Don't assume that persistent bloating, unusual bleeding, pelvic pain, vulval changes or other new symptoms are something you simply have to put up with because of your age, periods or menopause.
And if something has changed, persists, becomes more frequent or simply doesn't feel normal for you, speak to your GP. It probably is something entirely different, but always worth getting things checked out so they can be dealt with appropriately and in a timely way.