Monique Rainford

During residency training in obstetrics and gynaecology, we rotated through all the different aspects of the field to ensure that we were adequately trained. Perhaps the most dreaded rotation was in the sub-specialty of gynaecologic oncology - the care of patients with cancers of the female pelvis.

The hours were longer than the others and the patient care was significantly more demanding because, as might be expected, patients with cancer were sicker. Years later I have not chosen to pursue further studies in this field, some of the faces of my patients are permanently etched in my memory. Some have passed away, even while they were in the hospital.

I remember one woman was in her room for several weeks leading up to her death. She had ovarian cancer. In all those days that I visited her, I never remember her complaining. I remember another patient - she was in her 30s and was dying from cervical cancer. I still remember that she was able to smile. Cancer though is not just about dying with dignity but I encourage patients to fight it and some will win the fight.

The most common gynaecological cancers in women are endometrial cancer (cancer of the lining of the uterus), cervical cancer (cancer of the neck of the womb) and ovarian cancer. The stage of the cancer indicates the extent of the disease and these cancers are divided into four stages (each stage is further subdivided using specific criteria). The earlier the stage of cancer diagnosis, the more likely that it can be cured.

Cervical cancer

Cervical cancer is one of the most common cancers in Jamaican women. Even in its early stages, it can be detected by a Pap smear and the diagnoses can be confirmed by the sampling (biopsy) of the cervix. Infection with the human papilloma virus (HPV) is the greatest risk factor for cervical cancer.

Other risk factors include starting intercourse at an early age, many sexual partners or having a male partner with many partners, oral contraceptive use, smoking and lack of Pap smears. Women with any condition that can weaken their immunity (such as AIDS) are also at risk for cervical cancer.

Clinically a woman may experience abnormal bleeding or brownish discharge following douching, intercourse or spontaneously between menstrual periods. Cervical cancer is the only cancer with a reliable screening test that can prevent it in most women (the Pap smear). Currently the vaccine Gardasil, which is sold in Jamaica, can prevent infection with certain types of the HPV and likely prevent cervical cancer in some women.

Endometrial cancer

Endometrial cancer is the most common cancer of the female pelvis in the United States there is no pre-cancer screening test, most women have abnormal bleeding or discharge early in the disease which can aid in an early diagnosis and possible cure. The main factor which increases the risk of this cancer is an excess of the hormone oestrogen.

This may occur in some women who have infrequent and irregular periods. Other risk factors include obesity, never having had children and having menopause over the age of 52. Use of the oral contraceptive pill can protect against this cancer. A sampling (biopsy) of the uterine lining can diagnose this cancer. Ovarian cancer is the most deadly of these three cancers because it is usually not caught early. I will continue the discussion in my next article.

I encourage all women to take control of their health. Screen for cancer where possible, be alert to changes in your body and if you are living with the diagnosis, obtain your treatment and seek the appropriate follow-up care.