Women's Cancers

The following sections is included:

• Dedication
• Acknowledgements
• About the Authors, Artist and Contributors
• Preface
• Contents

I have written this book in the hope of providing women who have been told that they have a cancer with accurate information that combines both orthodox medical treatments along with complementary therapies. I also hope it proves to be a valuable resource for families and supportive friends…

The following sections are included:

• The Female Genital Tract
• The Lymphatic System
• Upper Abdominal Anatomy

My colleagues, medical oncologist Dr Mark Bower and specialist nurse Sr Catherine Gillespie, and I have developed this approach to patient care over many years of sitting in clinics explaining to patients where they are with their cancer, not just in physical terms, but conceptually in relation to their cancer and their life expectancy and its quality.

The fact that you are reading this book is almost certainly because you or a relative have been diagnosed as having cancer. The process by which that diagnosis was made will, I know, have caused you great distress and seemed to have taken ages. For the majority of you, hopefully, it will have taken no more than a few weeks, but those few weeks will have been psychologically and/or physically painful and stressful. You will almost certainly have gone to your GP, perhaps with a swelling in your tummy or some irregularity of bleeding or perhaps with pain. Your GP will have examined you, performed tests and referred you either to a general gynaecologist or to some form of rapid assessment clinic or perhaps directly to a gynaecological cancer specialist. A gynaecological cancer specialist will be a highly trained surgeon who will have specially trained in the area and will be somebody who you can feel certain is up to date in modern management of gynaecological cancer, who understands the different types of treatment and will work within a large team of individuals. These teams meet at what are called multi-disciplinary team (MDT) meetings on a regular (weekly or fortnightly) basis. At these meetings there are usually a minimum of two or more surgeons, a radiotherapist, one or more medical oncologists who prescribe chemotherapy, a radiologist who takes and reads ultrasound scans, X-rays, computerised tomography (CT), positron emission tomography (PET)-CT, and magnetic resonance imaging (MRI) scans, specialist oncology nurses and a pathologist. All of these consultants may well have junior members in their respective teams who will also attend these meetings and who you may see during your care. These meetings ensure that the treatment that you are offered is the optimal treatment and so that no one group (e.g. the surgeon or the radiotherapist) can steer you into the wrong therapy…

When a woman develops cancer in her genital tract, be it on the vulva (the outside of the vagina), the vagina itself, the cervix, uterus, tubes or ovaries, it is often the presumption that it is in some way related to sex. Often people harbour feelings of guilt as to whether they have done something wrong in the past that is now coming back to them in the form of a cancer. This impression has been further fostered by much of the tabloid press, where there regularly appear articles, suggesting that such and such cancer is because of ‘promiscuity’. The definition of ‘promiscuity’, that medical students are given, is the patient having had one more partner than their doctor! It is really a totally meaningless term. One person's promiscuity is another person's normality. Having said all of this, it is true that endometrial cancer is associated with never having been sexually active and not having had children…

The following sections are included:

• General Facts
• Explanation as to How CIN Arises
• The Way the Smear is Taken
• Colposcopy
• Prevention: HPV Vaccination
• Treatment of Abnormalities
• Cervical Cancer
• Stage IA2 Cancer
• Stage IB1 Cancer
• Stage IB2 Cancer
• Stage IIA to IV Cancer
• Surgical Procedures Referred to in this Chapter

This chapter covers the subject of ovarian cancer and Fallopian tube cancer. Fallopian tube cancer used to be thought of as a very rare condition and when it did arise, it appeared to follow a very similar course to that of ovarian cancer. However, since 2012 there have been new data that show that 70% of what were thought to be ovarian cancers, in fact have arisen within the Fallopian tube. They arise at the end of the tube closest to the ovary (distal end) and then it appears the early abnormal cells implant in the ovary, giving the impression that the cancer has arisen in the ovary. In practical terms this does not make for any difference in cancer management. They are ‘staged’ in the same way and are treated in the same way. The staging refers to how far the cancer has spread. Because of the great similarities, although the chapter refers to ovarian cancer, it also applies to Fallopian tube cancer. There will be no further mention made of Fallopian tube cancer in this chapter, but what is written here relating to ovarian cancer would apply to you if you have Fallopian tube cancer…

The following sections are included:

• General Facts
• How is the Diagnosis Made?
• What happens once the Diagnosis of Cancer is Made?
• Radiotherapy
• Fertility Sparing Treatments for Endometrial Cancer
• Surgical Procedures Referred to in this Chapter

The following sections are included:

• General Facts
• Diagnosis
• Sexual Function

The following sections are included:

• Introduction
• Epidemiology
• Screening
• Breast Self-Examination
• Once You or Your Doctor Find a Lump
• Management of Early Cancer
• Radiotherapy
• Management of Advanced Cancer
• Sex and Body Image
• How Do I Cope With My Diagnosis and Disease
• Useful Addresses

The following sections are included:

• General Facts
• Hydatidiform Mole
• Gestational Trophoblastic Neoplasia (GTN)

Chemotherapy can be used in most of the cancers that affect women's gynaecological organs, although the commonest time when chemotherapy is used is for women who have ovarian cancer. There are lots of misconceptions that people have about chemotherapy. First, and most important, is that one often hears people say ‘it doesn't work’. This simply is just not true. The difficulty with chemotherapy is in some ways having a picture in your mind's eye of what a cancer looks like and then imagining a drug being poured in, usually via a drip into a vein, and then thinking how that can get rid of cancer. The authors can quite honestly personally testify to having looked inside lots of people's tummies before chemotherapy and after chemotherapy and the difference is truly staggering. Lots and lots of tumour just literally disappears into thin air after chemotherapy…

Pain and cancer are inextricably linked in all of our minds. I think that probably one of the greatest fears people have when they are given a cancer diagnosis is that it will, at some point, result in them suffering from unbearable pain for which there is no treatment; in general, this is not true and very uncommon. In addition, many people before their diagnosis presume that they cannot have cancer because they have no pain. Ironically, this is one of the greatest misconceptions, since many cancers unfortunately are not discovered until later than they could have been, specifically because they have not caused any pain. This very much applies to problems in the ovary where there are effectively no pain receptors. It is also true that if one feels pain in a leg or an arm or, for instance, in a finger, then the brain is very good at knowing exactly where the pain is, i.e. if the pain is in your right index finger, the problem is likely to be in your right index finger as well. It would be inconceivable that the problem would be in your left ring finger. The same does not apply with pain felt in the internal organs; thus, the ovary tends not to cause pain unless there is bleeding into it and it rapidly expands or if it twists so that its blood supply is cut off, after which the pain will be a diffuse pain, usually arising in the lower abdomen. Pain in the uterus is often felt as lower tummy pain, but can also be felt as lower back pain or upper thigh pain. Even more confusingly, the brain can sometimes mistake pain arising from the right for pain felt on the left and vice versa…

This chapter discusses the pros and cons of various treatments. It has been written by one of the authors (JRS) and is therefore written in the first person. It is divided into separate sections on hypnotherapy, acupuncture, homeopathy, meditation, spiritual healing and Reike. In addition, there is a section on psychotherapy and counselling. This chapter is designed to give an overview and following this, there are further chapters on hypnotherapy (Chapter 15), nutrition (Chapter 16) and cardiac synchronicity (Chapter 17)…

Editorial note from JRS: I have referred to Shaun since 1988. At the time, I was running a hypnotherapy clinic at St. Mary's Hospital, London and Shaun was too. When I got stuck, I took to referring to Shaun who always seemed to have the answer. When I became a Consultant, I no longer had time to practice hypnotherapy and have since then worked closely with Shaun. His chapter shows great discernment in the art and practice of hypnotherapy and a more sophisticated approach than my own, which I have already described to you in the previous chapter.

If you search the internet for diet and cancer, you'll get over 140 million snippets of information at your fingertips in a matter of seconds. Some will be useful, some won't. Some will be based on sound science, some on anecdote and some on complete pseudo-science. Some may even be downright dangerous and could lead to serious nutritional deficiency or interfere with cancer treatment…

Editorial note from JRS: This chapter has come about because of an interesting juxtaposition of ideas. Shaun Hammond and I were discussing the difference in mental state between hypnotic trance and the place of otherness that one can reach by repetitive chant where the chant is in time with the heart beat and breathing. They feel similar, but are not the same. Tony happened to join the conversation and in great excitement told about a technique called cardiac synchronicity; this is a secular approach to repetitive prayer.

Bereavement is by definition the process we go through when we suffer loss of something or someone very special to us. In terms of this book, it therefore applies to the women diagnosed with cancer who are coping with the loss that this entails and to the relatives of the minority of women who will sadly succumb to their disease…

You may consider it brave, foolhardy, presumptuous or just plain not appropriate for a doctor such as me to even enter into this subject. My reason for including a chapter on this subject is that over the last two plus decades I have had the privilege to look after a large number of women who have either been cured of their cancer or have lived with their cancer for a long time before succumbing to the disease. I have become quite convinced that religion and spirituality allows people to cope better with their disease than those who see things in strictly secular, non-religious terms. The term spirituality is used, as meaning, the attempt to experience a sense of the transcendental, independent of religion. I would not dream of suggesting that I think that those with religion live longer with their disease, but I do believe that particularly for those who are living with cancer many of them do ‘live better’. You may think when you start this chapter that ‘I'm somebody who's not religious or spiritual so there's no point in reading this’, or that you are religious and once again, therefore, there's not much point in reading it because how does one change the way that one is? I think it is also important that I state here at the start of this chapter that I have no agenda whatsoever to proselytize for any specific religion. I myself could have been regarded as a non-practicing Christian for the first 35 years of my life and since then have practiced, or at least tried to, Christianity in a liberal Anglo-Catholic tradition. I do also have a keen interest in Eastern Orthodoxy, in particular in aspects concerned with Christian mysticism. I impart this information not through any desire to suggest that what I do is better than what anybody else does, but merely to be clear to you in my own position. Ironically, it has been the juxtaposition of looking after patients with cancer and HIV, watching their coping mechanisms and having to develop some of my own, coupled with a brief but severe bout of personal illness, and difficulty which propelled me along my own personal route…

It may seem strange to finish a book such as this with some conclusions. However, the book started with some key aims …

Websites have been suggested throughout the book and you may find Ovarian Cancer Action, McMillan and Marie Curie valuable resources.

The following sections is included:

• Glossary
• Index
• Cut-out 4 cusp diagram