Screening & Vaccination

What is pre-invasive disease?


Pre-invasive can also be known as pre-malignant or pre-cancerous disease. As the name indicates it refers to the very early stage of cancer development when abnormal changes occur in the tissue, which could be a pre-determinant for a possible future cancer.

What are the symptoms of gynaecological cancers?


Early detection is important to effectively treat gynaecological cancers and there are four important symptoms to be aware of:

  • Abnormal bleeding: is a very common indication that a woman is having problems with her reproductive system. If you have vaginal bleeding or discharge not related to normal periods and particularly after intercourse or after the menopause you should contact your doctor immediately. Gynaecological cancer will not always be the cause but abnormal bleeding is a symptom of some gynaecological cancers.
  • Abdominal swelling: if you experience swelling of the lower abdomen without weight gain else where; if this swelling does not improve with diet or exercise; if there is abdominal pain or you can feel a lump of mass in the lower abdomen you should contact your doctor. Gynaecological cancer may not be the cause, but this symptom is common to cancers of the fallopian tube and ovary.
  • Pain: Pain in the vulva may be a symptom of cancer in the vulva. If you experience any pain in the vulva or lower abdomen you should let your doctor know.
  • Itching and changes in the vulva: Constant itching in the vulva and changes in the way the vulva looks may be a symptom with cancer of the vulva. If you have vulval itching or if the skin on the vulva looks white, feels rough or develops a lump or ulcer you should let your doctor know.

HPV Vaccinations

Immunizing procedures have been developed in which a vaccine is injected into the body. This helps the body to produce immunity against a number of cervical cancer viruses. You can learn more about the vaccinations to prevent cervical cancer at our recommended "Cancer Literature on the Web" page at this site: HPV vaccines to prevent cervical cancer.

SCREENING FOR GYNAECOLOGICAL CANCERS

What is screening?

Screening is an examination or test designed to identify cancer before a women has any symptoms. This is to help find the cancer in its early stages of development, before it has had a chance to spread. Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done. The greatest chance for cure with cancer is preventing the disease and detecting it early. Discovering cancer early allows your doctor to be able to treat it while still confined to the primary site before spreading. Some cancers can be detected during routine screening procedures.

Does a positive screening result mean I have cancer?

Detection examinations, tests, or procedures used in screening are usually not diagnostic, but identify which woman is suspicious for the presence of cancer from those who are not. Actual diagnosis of disease is made following a consultation with a specialist and could include either a biopsy or other tests to assist in evaluating the symptoms.

What screening tests are available?

The National Screening Programme delivers the only gynaecological screening programme in New Zealand for cervical cancer. Other cancers are screened by routine examinations, which can be performed by your doctor:

SCREENING FOR OVARIAN CANCER

Current literature does not support screening for women at average risk in a normal population. Many of the screening tests available for ovarian cancer fail to aid in diagnosing early disease. By itself, each single testing method is imperfect. But using multiple tests in conjunction with a careful history, may contribute to earlier diagnosis for women with a hereditary ovarian cancer syndrome.

Pelvic Examination: For this examination, the doctor feels the vagina, rectum, and lower abdomen for masses or growths. Generally, this type of examination discovers advanced disease only and is not sensitive enough to detect very early cancers.

CA 125: For this test a blood sample is taken and the amount of CA 125 present is measured in a laboratory. CA 125 is not always found in women with ovarian cancer; however, it may be present in women who have other types of cancer or noncancerous ovarian conditions. Studies suggest that CA 125 tests alone are not reliable for screening for ovarian cancer.

Imaging: Ultrasound imaging is superior to physical examination because ultrasound can detect masses as small as mm measurements and can distinguish whether a mass is solid or fluid filled (cystic). A complex mass having both cystic and solid components may be cancer. Incorporating Colour Doppler technology to identify certain patterns associated with tumours seems to improve the usefulness of ultrasound screenings.

SCREENING FOR CERVICAL CANCER

A cervical smear test is not a test to look for cancer. It is a regular screening test that looks for abnormal changes in cells on the surface of the cervix (the neck of the uterus or womb). Some cells with abnormal changes can develop into cancer if they are not treated. Treatment of abnormal cells is very effective at preventing cancer. This smear test can be carried out by your general practitioner.

How often do you need a smear test?

The National Cervical Screening Programme recommends that women have a cervical smear test every three years from the time they turn 20 until they turn 70.

In some circumstances you may be advised to have a cervical smear test more often, for example, if you have had an abnormal result.

The test is also sometimes known as a pap smear.

The National Cervical Screening Programme
 The complete standards can be see on the National Screening Programme website.

Treatment Options for Abnormal Cell Change
Abnormal cell changes generally do not cause symptoms and are only picked up during screening tests. Screening tests are designed to check if abnormal cell changes have taken place. Abnormal changes in cells are common and some mild changes will disappear without treatment. Without treatment there is a risk that abnormal cells may develop into a cancer. Your doctor will discuss with you the best treatment which will depend on the type and severity of the abnormal cell change. These treatments are usually performed in a day stay theatre and could include:

  • LLETZ (an abbreviation for Large Loop Excision of the Transformation Zone), uses an electrical wire loop to completely removal abnormal cells from the transformation zone of the cervix.
  • Laser – is a medical instrument that produces a powerful beam of light and can produce an intense heat when focussed at close range. The beam is pointed at the abnormal area and used to destroy abnormal tissue or as a cutting instrument to remove precancerous tissue.
  • Cone Biopsy – cone shaped section containing abnormal cells is removed from the cervical canal. The biopsy is sent to the laboratory for examination under the microscope.
  • Excision – surgical procedure to cut and remove abnormal tissue
  • Diathermy – heat used to destroy or remove abnormal cells.

SCREENING FOR ENDOMETRIAL

There is no standard or routine screening programme as yet for cancer of the endometrium

Pap Smear
This test is designed to screen for cervical cancer; however, occasionally it may find show signs of an abnormal endometrium. During a regular office visit, a doctor uses a wooden scraper and/or a small brush to collect a sample of cells from the cervix and upper vagina. These cells are placed on a slide and sent to a laboratory to check for abnormalities.

Endometrial sampling
Endometrial sampling is the removal of tissue from the endometrium by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples. The sample is sent to a laboratory to check for any abnormalities. This test is commonly used to examine women who have abnormal vaginal bleeding.

Transvaginal ultrasound
This procedure is used to examine the vagina, uterus, fallopian tubes and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves known as ultrasound off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify any tumours by looking at the sonogram. This test is commonly used to examine women who have abnormal vaginal bleeding.