In the latest in a series of articles on cancer, Dr Chris Wheatley, a County Durham GP who specialises in gynaecological cancers, writes about them.

GYNAECOLOGICAL cancers, i.e. cancers of the ovary, womb, cervix, and vulva (outer genital area), are much less common than cancer of the breast. However, they still cause many preventable deaths.

Ovarian cancer is the commonest. Diagnosis is usually late, so the outcome is poor, but surgery and chemotherapy can improve the length of survival.

Endometrial (womb) cancer is the second commonest. The outcome is better, with 70 per cent of patients surviving long-term after treatment.

Cervical cancer is only the third commonest, despite its higher profile due to the cervical smear screening programme. Early diagnosis and treatment give a high cure rate of up to 85 per cent.

Vulval cancer accounts for only three per cent of gynaecological cancers and presents with an ulcer or lump.

Who is at risk and how can it be prevented?

FAMILY HISTORY: Women with two or more close relatives who have had cancer of the ovary or breast may be at increased risk of ovarian cancer. They should discuss this with their GP or practice nurse, who will refer them to the new Cancer Family History Service, if appropriate. Most can be reassured, but those considered to be at high risk could be offered preventative surgery or screening. The contraceptive pill reduces the risk by 50 per cent.

SEXUAL ACTIVITY: It is now known that cancer of the cervix is associated with human papillovirus, which is a sexually transmitted disease. This usually has a transient harmful effect on the young teenage cervix. The more partners a girl/woman has, the more likely she is to pick it up, so there is a lot to be said for delaying first sex until adulthood and having one monogamous relationship. Failing that, protection, e.g. with condoms, is important.

LIFESTYLE: Obesity is known to increase the risk of cancer of the womb, while smoking is associated with an increased risk of cancer of the cervix.

HRT: Oestrogen only HRT gives a high risk of cancer of the womb, so should only ever be taken by women who have had a hysterectomy. Recent evidence suggests continuous combined HRT (oestrogen and progestogen) is associated with no increased risk.

What symptoms should you look out for?

POST-MENOPAUSAL BLEEDING: Bleeding from the womb a year or more after periods had apparently stopped, may be due to endometrial cancer, though in most instances it is not, particularly if HRT is being taken. Women who have abnormal bleeding on HRT should stop this. If bleeding still continues for more than four weeks, referral to a gynaecologist is needed. If bleeding ceases and does not recur for three months, HRT could be restarted.

POST-COITAL BLEEDING: Bleeding after intercourse can be due to cancer of the cervix, though again most cases are not. Established "invasive" cancer of the cervix can be associated with negative cervical smears so the GP will refer to a gynaecologist if he/she thinks the cervix looks suspicious.

SWELLING OF LOWER ABDOMEN: Often associated with other vague symptoms such as a heaviness, aching, or bowel symptoms and can be due to cancer of an ovary in women over 45 years old. The problem is that in the majority of cases, these symptoms are due to less serious underlying conditions e.g. irritable bowel syndrome. Your GP will have faced this problem many times and can often make a diagnosis by examination, but if he/she thinks there is a suspicious swelling he will refer you to a gynaecologist. Probably at the same time, he will take a sample of blood for a tumour marker called CA125. The result of this test should be available when you see the gynaecologist so that, together with an ultra-sound examination, a diagnosis can be made the same day.

What screening tests are available?

CERVIX: Everyone should be aware of cervical smear screening. This detects early changes, which occur before actual invasive cancer develops and, as a result, has greatly reduced the incidence of, and death from, cervical cancer. The Government has recently changed its advice on the timing of smears to target the age group most at risk, while reducing the number of unnecessary smears. It now advises that the first routine smear is not necessary until the age of 25 years, and that smears should then be taken every three years to age 50, and then every five years until age 65.

WOMB: There are no satisfactory screening tests for endometrial cancer.

OVARY: There are no satisfactory screening tests for women in general, but there is an ongoing national trial involving a combination of ultrasound and blood testing for CA125.

Key Points:

* Women with a strong family history of ovarian cancer should discuss this with their GP or practice nurse.

* Do not start sexual relationships too young, keep the number of partners to a minimum, and always have safe sex.

* Always have cervical smear screening at the advised intervals.

* Report any of the above symptoms to your GP.