Breast cancer
What is breast cancer?
Breast cancer starts in the ducts or lobules of the breast. Cells lining the ducts or lobules can grow out of control and develop into cancer.
Some breast cancers are found when they are still confined to the ducts or lobules of the breast. This is called pre-invasive breast cancer. The most common types are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ
(LCIS).
Most breast cancers are found when they are invasive. This means the cancer has spread outside the ducts or lobules of the breast into surrounding tissue.
There are several categories of invasive breast cancer.
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Early breast cancer: contained in the breast but may have spread to one or more lymph nodes in the armpit.
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Locally advanced breast cancer: may have spread to places near the breast, such as the chest (including the skin,muscles or bones of the chest), but the cancer isn’t found in other areas of the body.
- Metastatic breast cancer: the cancer cells spread from the breast to other areas of the body, such as the bones, liver or the lungs. It may also be called advanced breast cancer.
How common is it?
Breast cancer is the most common cancer in Australian women. One in 8 women will be diagnosed with breast cancer by
the age of 85. Around 13,000 women are diagnosed with breast cancer each year.
Breast cancer can occur at any age. It is more common in women aged over 60 but around one-quarter of women are
younger than 50.
Men can also develop breast cancer, although this is rare. Around 110 men are diagnosed each year in Australia.
What are the causes?
The exact cause of breast cancer is unknown, but there are factors increase the risk to developing this disease:
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Having several close relatives, like a mother, sister or daughter, diagnosed with breast cancer – these relatives can be from either the mother’s or father’s side of the family
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If you have had breast cancer before
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If you have had certain breast conditions such as atypical ductal hyperplasia, ductal carcinoma in situ or lobular carcinoma in situ.
Having some of these risk factors does not mean that you will develop breast cancer.
Most women with breast cancer have no known risk factors, aside from getting older.
Ovarian cancer
Ovarian cancer is a malignant tumour in one or both ovaries. It is often called a silent disease because the symptoms can be vague.
Types of ovarian cancer
Epithelial ovarian cancer
- starts in the surface of the ovary (epithelium)
- most common type of ovarian cancer (90% of ovarian cancers)
- includes serous, mucinous and endometriod cancers.
Non-epithelial cancers
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starts in different parts of the ovary
- includes germ cell ovarian cancer, which starts in egg-producing cells, usually affects women younger than 30
- also includes sex-cord stromal cell cancer, which develops in the cells that release the female hormones.
How common is it?
- In NSW, there are about 450 cases of ovarian cancer each year.
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It's the 10th most common cancer in women.
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Average age at diagnosis is 63.
What are the causes?
The cause of ovarian cancer is unknown.
However, the following factors increase a woman's chance of developing ovarian cancer:
Age:
Most common in women over 50 and in women who have stopped menstruating (have been through menopause). The risk increases with age.
Child-bearing history:
Women who haven not had children, or were unable to have children, may be slightly more at risk.
Hormonal factors:
Includes early puberty or late menopause and using oestrogen-only hormone replacement therapy (HRT).
Women who have taken the contraceptive pill for a number of years seem to have a lower risk. There is also limited evidence suggesting that breastfeeding may protect against ovarian cancer.
There is no proven link between ovarian cancer and a high-fat diet, using talcum powder around the genital region, or the mumps virus.
Family history
In about 5-10% of women diagnosed with ovarian cancer there may be an inherited faulty gene in their family. This fault increases the risk of developing ovarian cancer.
There are two genetic conditions known to cause an increased risk of ovarian cancer:
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Hereditary breast/ovarian cancer
- Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC).
You may want to talk to your doctor or go to a family cancer clinic if you think you are at risk.
What are the symptoms?
Ovarian cancer is often a silent disease in the early stages, which means many women have no symptoms. If symptoms do appear, they are usually vague and may include:
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swelling, pressure, discomfort or pain in the abdomen
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heartburn, nausea or bloating
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changes in toilet habits, such as constipation, diarrhoea and frequent urination due to pressure
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tiredness and appetite loss
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unexplained weight loss or weight gain
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changes in your menstrual pattern or postmenopausal bleeding
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pain during sex
These symptoms are common to many illnesses, and most women with these symptoms will not have ovarian cancer. Only tests can confirm the diagnosis.
Cervical cancer
Cervical cancer is a malignant tumour in the tissues of the cervix.
The two main types of cervical cancer are named after the type of cell from which they originate.
- Squamous cell carcinoma-- the most common, accounting for 80% of all cervical cancers. It starts in the squamous or skin-like cells of the cervix.
- Adenocarcinoma-- a less common type of cervical cancer, which develops from the glandular cells. This type is more difficult to diagnose because it starts higher in the cervix and is more difficult to reach with the brush or spatula used in taking a Pap test.
Cervical cancer can be microinvasive or invasive:
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Microinvasive cancer -- cancer cells have broken through the boundary between the epithelium and stroma. Cells haven't spread more than 5mm into the cervix tissue.
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Invasive cancer -- cancer cells have spread into the stroma to a depth of more than 5mm. Cancer may have spread to nearby tissues (like the vagina, rectum or bladder).
Cervical cancer can spread to other parts of the body through the lymphatic system.
How common is it?
In NSW, about 200 women are diagnosed with cervical cancer each year and cervical cancer accounts for 1.4% of all cancers in females.
What are the causes?
The exact cause of cervical cancer isn't known but some forms of he Human Papillomavirus (HPV) or gential wart virus have been linked to cervical cancer.
The causes of cervical cancer are largely unknown. However, some factors increase a woman's risk:
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HPV infection which is the name for a group of wart viruses and a common infection affecting the surface of any part of the body, including the skin, vagina and cervix. More than 100 types of the virus have been identified but only some affect the genital area. Around eight out of 10 women will become infected with the genital HPV at some time in their lives and, for most, it will clear up on its own. Women only find out they have the HPV if it shows up on a Pap smear as it causes no symptoms. Having HPV does not mean you will get cervical cancer. Most women who have the HPV infection never get cervical cancer. Only a few types of the HPV result in cervical cancer.
- Smoking produces chemicals that may damage the cells of the cervix and make cancer more likely to develop.
What are the symptoms?
Early changes in the cells of the cervix (epithelial abnormalities) rarely cause symptoms, which is why doctors encourage women to have regular Pap tests.
If early cell changes develop into cervical cancer, the most common signs include:
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vaginal bleeding between periods
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bleeding after intercourse
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pain during intercourse
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unusual vaginal discharge
- vaginal bleeding after menopause
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excessive tiredness
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leg pain or swelling
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low back pain
All these symptoms are common to many conditions and may not mean you have cervical cancer. However, if you have these symptoms you should have them checked by your doctor.
Vaginal cancer
Types of vaginal cancer
1. Primary vaginal cancer
The two main types of primary vaginal cancers are named after the cells from which they develop.
Squamous cell carcinoma:
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The most common type of vaginal.
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Usually found in the upper part of the vagina.
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Most commonly affects women who are 50-70 years old
Adenocarcinoma:
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Usually affects women under 20 years of age but occasionally occurs in other age groups.
Other types of vaginal cancer that are very rare include melanoma, small cell carcinoma, sarcoma and lymphoma.
2. Secondary vaginal cancer
Secondary cancers in the vagina (those that have spread from other parts of the body) are more common than primary vaginal cancer.
Secondary cancers usually come from the cervix, the lining of the womb (the endometrium), the vulva or from nearby organs such as the bladder or bowel.
What are the causes?
As with many cancers, the exact cause of most vaginal cancers is unknown, but research is going on all the time to try to find the cause. Possible causes include:
DES
A hormone drug called diethystilboestrol (DES) has been identified as a cause of a particular type of cancer of the vagina.
Between 1940 and 1970, DES was prescribed to pregnant women to try to prevent miscarriages. The female children of women who took DES during pregnancy have a slightly increased risk of developing a type of cancer of the vagina called clear cell adenocarcinoma. (Only one in 1000 DES daughters develop vaginal cancer. The incidence peaked in the 1970s and is now decreasing.)
Although DES and some other female hormones (oestrogens) can be safely used to treat some other medical conditions, DES is no longer used during pregnancy.
HPV
The human papilloma virus (HPV), which is the name for a group of wart viruses, is a risk factor for vaginal cancer.
HPV is a common infection affecting the skin surface of any part of the body, including the vagina and the cervix.
Other possible causes
Cervical cancer: women who have had cervical cancer or pre-cervical cancer in the past are more likely to get vaginal cancer.
Radiotherapy to the pelvic area: women who have had radiotherapy to the pelvic area also have a slightly higher risk, but this complication of radiotherapy is very rare, and women who have had this treatment still only have a tiny risk of developing vaginal cancer.
What are the symptoms?
The most common symptoms of vaginal cancer are:
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blood-stained vaginal discharge
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bleeding after sexual intercourse
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pain
Problems with passing urine, such as blood in the urine, the need to pass urine frequently and the need to pass urine at night, can also occur.
Pain in the back passage may sometimes occur.
Vulvar cancer
Types of vulvar cancer
Squamous cell carcinoma
Most (90%) cancers of the vulva develop from the squamous cells in the vulva. Squamous cell cancers usually grow very slowly over a few years.
Vulvar melanoma
Melanomas develop from the melanin, the pigment-producing cells that give the skin its colour.
This is the second most common type of vulvar cancer, but is much less common than the squamous cell type. Only about 4% of vulvar cancers are melanoma.
Adenocarcinoma
These are very rare. Adenocarcinoma of the vulva develops from cells that line glands in the vulvar skin. Paget’s disease of the vulva is a pre-malignant condition where glandular cells spread out from these glands and across the skin of the vulva.
Verrucous carcinoma
This is a rare, very slow-growing type of vulvar cancer, which looks like a large wart.
Sarcomas
These are extremely rare. Sarcomas develop from cells in tissue, such as muscle or fat under the skin, and tend to grow more quickly than other types of cancer.
What are the causes?
Precancerous conditions
Although the cause of cancer of the vulva remains unknown, it has been linked to certain precancerous conditions.
A condition called VIN (vulvar intraepitheli al neoplasia) occurs in the skin of the vulva and can develop into vulvar cancer if left untreated.
The human papilloma virus (HPV), or wart virus, also appears to be associated with VIN. Almost one-third of vulvar cancers develop in women who have VIN. Women who have had multiple sex partners may be more exposed to a variety of HPV, but women who have had only one sex partner can develop VIN.
In younger women, a precancerous lesion (area of tissue) is more likely to be associated with HPV, and this increases the risk of vulvar cancer. This risk is increased in women who smoke. Older women who get vulvar cancer usually don’t have a link with HPV.
Skin conditions
Women who have certain non-cancerous skin conditions for a long time have an increased risk of developing vulvar cancer. These conditions, called vulval lichen sclerosus and vulval lichen planus, affect the skin in the vulvar area. The skin can become inflamed and itchy, and split and crack, causing pain. The vulva may become distorted, and change in shape and size.
Almost two-thirds of vulvar cancers occur in women who also have lichen sclerosus, but only a small percentage (1-2%) of women with lichen sclerosus will go on to develop vulvar cancer.
Smoking
Cigarette smoking increases the risk of developing both VIN and vulvar cancer. This may be because smoking can make the immune system work less effectively. Cancer of the vulva, like other cancers, is not infectious and cannot be passed on to other people. An inherited faulty gene does not cause it and so other members of your family are not likely to be at risk of developing it.
What the symptoms?
The most common symptoms of cancer of the vulva are:
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itching, burning and soreness of the vulva
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a lump, swelling or wart-like growth
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thickened, raised, red, white or dark patches on the skin of the vulva
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bleeding or a blood-stained vaginal discharge
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burning pain when passing urine
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pain in the area of the vulva
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a sore or ulcerated area on the vulva
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a mole on the vulva that changes shape or colour
Cancer of the vulva usually takes many years to develop but, as with other cancers, it is easier to treat and cure at an early stage.
Any of the above symptoms can be a sign of many conditions other than cancer, but always get your doctor to check them.
Uterine cancer
Types of uterine cancer
1. Endometrial cancer
- Affects the lining of the uterus (endometrium).
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About three-quarters of uterine cancers- called adenocarcinomas.
Other types of endometrial cancers include:
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adenosquamous carcinoma
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serous carcinoma
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clear cell carcinoma
These types of cancer grow more rapidly and are typically more aggressive than adenocarcinoma.
2. Uterine sarcomas
- Affect the smooth muscle tissue of uterus (myometrium) or the connective tissue (stroma).
- More likely to spread rapidly.
- The three types of uterine sarcomas are:
- endometrial stromal sarcoma
- mixed Müllerian sarcoma
- leiomyosarcoma.
How common is it?
About 580 women in NSW are diagnosed each year.
Accounts for about 4% of all cancers in women.
Most common in women over 50.
What are the causes?
In most cases, the exact cause of cancer of the uterus is unknown. Some factors may increase a woman's risk:
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Age – more common in women aged over 50
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Being menopausal – most common in postmenopausal women
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Endometrial hyperplasia, a condition that occurs when the endometrium grows too thick
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Never having children or infertility
- Early menarche (first menstrual period)
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High blood pressure (hypertension) and diabetes
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Obesity
- A family history of ovarian, endometrial, breast or bowel cancer
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Previous pelvic radiation for cancer
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Ovarian tumours or polycystic ovary syndrome
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Taking oestrogen hormone replacement without progesterone
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Taking the drug tamoxifen for the treatment of breast cancer. If you are taking tamoxifen, you should discuss this risk with your doctor.
Uterine cancer is not caused by sexual activity and cannot be passed on this way.
What are the symptoms?
- abnormal vaginal discharge or bleeding, particularly after menopause (can appear watery or bloody, and may be smelly)
- difficult or painful urination
- pain during sex
If you have specific question about cancer and your body you should seek advice from your doctor.