Monique Rainford

(Part I was published on November 21)

As I mentioned in my previous article, ovarian cancer is the most deadly of the three most common cancers of the female pelvis. The risk factors for this cancer include having no children, women who have difficulty getting pregnant and women who delay pregnancy until an older age.

Ovarian cancer is more common as a woman gets older, especially if she is between 50 and 70 years old. Women who have used oral contraceptive pills, have a larger number of children or breastfeed have a lower risk of this cancer.

In the United States, the total number of women who die from ovarian cancer is greater than the sum of women who die from both cervical and endometrial cancer. This mainly occurs because most of these cancers are diagnosed at a later stage. It is possible that some of these cancers could be diagnosed early and it is important that if a woman feels certain symptoms, she checks with her doctor and try to determine a cause.

Frequent urination

Some of the symptoms women may experience include an increase in the size of her abdomen, bloating, fatigue, indigestion, constipation, back pain and frequent urination.

Many other conditions can cause these symptoms but it is important that the woman is thoroughly evaluated to attempt to ascertain a cause. Her evaluation should include a pelvic examination and, in some cases, an ultrasound done through the vagina may be helpful.

If a woman is past the menopause, and she has a tumour in her pelvis, a blood test called CA -125 may help to determine if the tumour is more likely or not to be cancer.

Unfortunately, none of the tests that I have mentioned above are good screening tests for women who have no symptoms and are at a low risk of this type of cancer.

Treatment of the gynaecologic cancers may involve surgery, radiation and or chemotherapy. The best treatment is determined by the stage of the cancer and the organ that is affected. For example, early stage cervical cancer may be completely cured by surgery. Conversely, in stage 3 or 4 ovarian cancer, the treatment is usually surgery followed by chemotherapy.

Cervical cancer and HPV

Dear Dr. Rainford,

I have recently been diagnosed with at least stage CIN 2 cervical cancer and I am awaiting an appointment to have an operation under general anaesthetic. My question is, I obviously have the human papillomavirus (HPV) although I have never had warts, am I contagious? I have a long-term female partner and I wish to know whether I can pass this virus to her; we have had unprotected sex for the past year. Could you please let me know about oral sex as well please?

Dear Reader,

CIN or cervical intraepithelial neoplasia is classified into three grades 1, 2 and 3. It is not cervical cancer but a precancerous change that in a percentage of women could lead to cervical cancer if left untreated. CIN 2, 3 and cervical cancer are associated with high-risk HPV such as types 16 and 18.

Genital warts are associated with low-risk HPV and these are not associated with cervical cancer.

Therefore, it is likely that you have been infected with high-risk HPV and not necessarily low-risk HPV and thus it is not surprising that you have never had warts. The HPV can be transmitted in a lesbian relationship by oral-genital sex or skin to skin contact but it is usually the low risk types. Nevertheless, it is important that your partner have regular Pap smears to screen for any cervical abnormality. Other infections that can be transmitted by oral sex include herpes and possibly HIV.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.