Cancer
Understand different cancers and get support if you or someone close has a diagnosis. Plus, find information on common symptoms and treatment.
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From explaining treatment to how to deal with their feelings, our guides can help.

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Sometimes it can be prevented, but we’ve got tips to help you prepare just in case.

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Let’s look at some of the terms you might hear experts say and what they mean.
Concerned about symptoms?
With or without insurance, we can help you
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You have unlimited access to GPs and nurses around the clock, who can give you advice and support for any health worries.
If you think you have symptoms of cancer, call our Direct Access† cancer team on 0800 012 1305^ to get specialist advice.
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No problem. We can still help you on a pay-as-you-go basis.
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Check your moles
for signs of cancer
Once a month, it’s good to look for changes in how your moles look or feel.

Understanding risks
as you age
While age increases cancer risk, there's still lots you can do to lower the risk.

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Is burnt food a cause? What about phones? Our experts have the facts you need.

Tips for taking care
in the sun
Protecting your skin can help lower your risk. And it’s not just about sun cream.
Inside Health:
Managing your cancer risk
Causes of cancer | Awareness and prevention | Myths
Watch in 44 mins
1 in 2 people will develop some form of cancer during their lifetime. It’s important to be aware of any new or worrying symptoms, as getting cancer diagnosed at an early stage can make a real difference and increase chances of survival.
music
Hi, everyone. Welcome. Today's topic is cancer, sometimes called the big C.
I think the word cancer itself can create a lot of anxiety, a lot of fear
because for so long we've associated cancer with death. But today we're gonna talk about cancer,
why it's important to talk about it, and why cancer doesn't necessarily mean death.
It's not all doom and gloom. So I'm joined by Tim and Rebecca from Bupa.
And if I could come to you, first of all Tim, let's start by explaining the word cancer.
What does it mean? What is it? Sure. I think most people realise our bodies are made up of trillions of different cells,
everything from fingernails, to blood cells, to hair cells. The thing that always amazes me is these trillions of cells just get on with it.
They're born, they grow, they do their stuff and they die. They respond to various things from inside the body
and from outside the body, whether it's environment, diet, et cetera. Sometimes those control mechanisms will go wrong
and those cells will start to either grow out of control or not die when they should die.
And we call those growth tumours. But a cancer is a tumour that just doesn't know when to stop.
It invades the tissues around it, it can get into the bloodstream and it can spread to other organs
and we call that metastasis. So cancer's a malignant growth and you may hear them call that
or you may hear them call malignant tumours as well. And there's probably about 200 different types of cancer that we recognise.
It always amazes me 'cause sometimes people talk about finding a cure for cancer,
but like you say, there are 200 different cancers and is it ever possible to find a single individual cure
for all cancers, do you think? I think that's not something that is certainly gonna happen
probably not within our lifetimes, but we are getting closer because we understand more and more about what causes cancer,
and we are now looking at treatments that are aimed at those causes rather than just killing off the cancer cells.
So we're definitely moving in the right direction with it. And what's the picture in the UK at the moment
when it comes to cancer? Cancer's very common. There are probably about 3 million people
living with cancer in the UK at any one time. And there are about 387,000
new cases of cancer every year in the UK. So that's over a thousand a day.
But every 90 seconds somebody will get that diagnosis of cancer. And if you were born after 1960,
there's probably about a one in two chance that you're gonna get cancer at some point in your life. And that sounds scary, doesn't it?
One in two chance. It used to be one in three not that long ago. So what's changed?
Has as cancer become more common? The biggest change is that people are getting older.
Cancer is still a disease of older people primarily because these controlled mechanisms in the cells
gradually fail over time. So with an ageing population there are gonna be more cancers,
there's more screening programmes, people are becoming more aware of cancer and talks like this I'm sure and I hope will help that.
So we're picking up more cancers as well. And I think when it comes to cancer,
we've spoken a little bit there about what cancer actually is, which it's really interesting the way you've put it.
What are the causes of cancer? The causes of cancer, for some cancers we just don't know.
The causes of cancer basically are things that disrupt this control mechanism in yourselves.
So it can be external factors, things like cigarette smoking, exposure to certain chemicals,
obesity we think causes a significant number of cancers. Hormone changes can cause some cancers
and other lifestyle things can be involved there as well. But also it is just changes in the genes
that control these cancers. Now these can be changes that you are born with. There are changes that can just happen at random
over the course of your life or sometimes they're genetic changes that you've actually inherited.
So can people reduce their risk of cancer? You can and you can reduce your risk of some cancers
quite significantly. First thing to do, if you smoke, please stop.
Smoking is the biggest risk factor, not just for lung cancer, which you don't everybody thinks of but mouth cancer,
throat cancer, esophageal cancer, stomach cancer, some skin cancers to a certain extent, even bladder cancer.
So smoking can cause a lot of cancers. Obesity is a significant risk factor for a lot of cancers.
And again, it's not the obvious things like you'd think, okay, bowel cancer is, I'm overweight, prostate cancer, breast cancer.
So healthy lifestyle, avoiding things like smoking, avoiding excessive alcohol.
You stick to the limits, 14 units three or more days a week, don't binge drink because prolonged liver damage
can cause cancer. It's really, a lot of it is common sense. Well, yeah, it always comes back
to those healthy lifestyle measures that we know about, that we talk about all of the time.
But often, life happens as well and it can be really difficult to implement very healthy lifestyle when none of us are perfect.
I think obesity is always an interesting one because we know that more people in this country are above a healthy weight than a healthy weight.
And I think sometimes the individual, it's difficult for individuals to get control of that.
Do you think that there needs to be... What changes need to happen I guess at a national level,
government level to help people be a healthier weight? Because we know that it is a big risk factor for cancer.
We have to look at the information that we provide for people to help them make healthy choices.
But we also have to have to accept some people won't make those healthy choices. So I think you have to be a little bit paternalistic
and look at cutting down on things like ultra processed foods, because adding artificial substances into natural food,
we were designed to run on certain type of fuel. If you put diesel in your petrol car, it won't like it.
Put the wrong fuel into your body and things are gonna start going wrong. And then what about genetics?
Because we know that genetics play a role when it comes to cancer. How important are our genes
'cause we have no control over those. We don't have any control over our genes. We do have some control over things
that might damage our genes as we get older. So again, I come back to things like smoking and obesity.
We're not quite clear how obesity actually works in increasing cancer risk, but it's causing some kind of genetic damage.
When people talk about genes and genetics, they may be mean different things. So there's the genetics that you're born with,
the genes that you've got, and any mutations or changes in those genes. And then there are genetic changes that do run in families.
Now people may say I'm at risk, there's a big history of cancer in my family,
but as I said, one in two of us may get cancer. We're all going to know a family member who's had cancer.
If you have a large family, you're gonna think I'm at high risk. There's a lot of people in my family with cancer. But if you look at things like cancers
at an early age in your family, that's potentially a risk factor for you. People who have a history of linked cancers,
so women who have had breast cancer and ovarian cancer together, that's a significant risk factor.
There are some different ethnic groups, whether there are different risk factors, people who have had more than one cancer in their lifetime
that suggests they may have a genetic problem which could be inherited. Again, if you're worried, talk to your doctor,
there are test that can be done. And if you are at risk, two things.
The fact that you've got a risk factor doesn't mean you're gonna get cancer. But the fact you haven't got any risk factors
doesn't mean you are not going to get cancer. So still have to follow all the advice on healthy eating and not smoking, et cetera.
So when it comes to those sort of specific genes, and I think the most common one that people have heard of is the BRCA gene
when it comes to breast cancer, what proportion of cancers are linked to specific gene mutation?
In terms of inherited genes, probably not more than about 10% of all cancers.
Pretty much all cancers, you could probably trace back to a genetic fault somewhere. But it's something that has appeared entirely at random
that isn't inherited. But 10% is significant and if you one of those at risk groups, it may mean that your risk
could be a lot higher than 10% of getting cancer. 'Cause it's interesting, isn't it? 'Cause we talk about
how genes are inherited from our parents, but actually those lifestyle behaviours
that you've spoken about are often inherited from our parents as well. We're more likely to have similar behaviours
to what our parents and what our family do. And then also the environmental things that, where we live, if we're exposed to certain chemicals,
pollution, they kind of run in families as well. So I guess when you're thinking about your family history,
it's quite complex, isn't it? Oh, it's very good. There are so be different factors in play as you said
and there's only so much that you can alter. So it's all about being aware
and any worries at all get advice. You can get advice from your GP, the NHS website,
Bupa website, virtual GP consultations with Bupa. There are so many ways now.
Really don't die of ignorance as they once said about another disease. Exactly. Tim, thank you so much.
That was really helpful to sort of set some context and give us some general information about cancer.
Really interesting statistics as well. So Rebecca, let's have a chat with you.
So you are the medical director in healthcare management at Bupa. And what I'd love to do is talk about some of the ways
in which we can be proactive with our health to keep ourselves healthy, but more specifically as well to reduce our risk of cancer
but also, what are some of the signs and symptoms we should be looking out for to be vigilant
and to pick up and detect what could be a cancer early? I think we're all really well aware
of some of the common signs of symptoms. Checking for breast lumps for example and checking for changes and the appearance
or the texture of your breasts. But actually there are lots of other things that you should be on the lookout for; lumps in other parts of the body, for example.
And I think something that's been in the media a lot recently has been about changing bowel habit. So that might mean going to the loo regularly
or becoming more constipated than normal and any change in terms of blood in the poo as well.
I think people are well aware to look for moles and changes in their shape or size, colour of them.
But people should also be on the lookout for new moles. And I think some of the less spoken about symptoms
that it's really important to be transparent about in women is vaginal bleeding. So any vaginal bleeding after sex, in between periods
and after the menopause should definitely be a reason to go to the doctor. I think finally, there are some other symptoms
that it's also important to be aware of. So persistent heartburn, persistent bloating,
as well as symptoms like a cough or shortness of breath that won't go away.
Those would all be things that we want people to be aware of. And I think, often the advice that I give to people is,
if there's something unusual that's not quite right for you, whatever it is, however obscure it is,
if you just have that sense that, this doesn't seem quite right, just speak to a doctor about it 'cause at the very best,
we can just put you at ease, and at the very worst, if there is something going on,
we're gonna detect it so much sooner. What about younger people? So we do tend to think of cancer
as something that affects older people and it is more prevalent in older people but same people at under the age of 35.
Are there specific signs and symptoms that people who are younger should be looking out for? Yeah, it's not as straightforward answer,
Zoe, Unfortunately. Some of the symptoms that happen in younger adults are really generalised and quite vague.
Things like persistent tiredness for example, or loss of appetite, unexpected weight loss
when you're not even trying to. And that's made more complex because some cancers are actually more common in young adults.
I think it comes down to the point that you just made, which is it's about understanding
what's your version of normal, what's normal for how your body feels and looks,
and becoming an expert in that so that if something doesn't feel quite right then you know that it's time to speak to a professional.
Do you think younger people are less likely to come forward and if so, why?
I mean, I think people can feel embarrassed about symptoms
and they don't want to bother the doctor, and I think we should rest assured
that that's what doctors are here for, it's our job. We are here to help regardless of whether that's giving you some reassurance
or checking out your symptoms and saying, actually I think this is probably worth something
that we need to investigate. Maybe one of the, well, I hope anyway, one of the things that might help younger people
is a general, better awareness of our bodies, feeling more comfortable at exploring our bodies,
at looking at our poo, at using a mirror to look at our vulva for example,
which I know with my older patients they can be quite squeamish about things like even looking at their poo. And I feel like that message
hopefully is getting through to younger people. What would you say to people about that? Yeah, I completely agree.
I think there used to be lots of advice about the best way to check for things and even recommending the best time to check for things.
I remember reading something in the media that women should be checking their breasts in the shower just before their period.
Actually, I think it's probably more generalised than that. People just need to check in with themselves
about exactly what's normal, what their poo looks like, what the vulva looks like, and do that on a regular basis
at different times of the month. That's particularly important for women on their periods because the body changes a lot so that they can become aware of what changes look like
and if they feel different. It's really bizarre that we have these bodies, we own them, their ares, we have to look after them.
There are responsibility yet sometimes we feel more comfortable letting somebody else
look at them or touch them in certain places but they're ours so own them people, look after them.
So Rebecca, what about screening? We're very lucky that in this country we do have great screening programmes for some cancers.
Can you tell us which cancers and a bit more about them? There are three main national screening programmes
in this country. The first, which people may not actually be that familiar with is bowel screening.
That happens every two years for people age between 60 and 75 in England.
Starts a bit younger in Wales at 58 and in Scotland at 50. Breast cancer screening is something
that people might be really familiar with. That happens every three years for women age between 50 and 70.
And there's actually a trial seeing if we can extend that age period from 47 up to 73.
And cervical cancer screening is something people may already be very familiar with as well.
Again, in England, that's offered every three years. Starts at 25 up until 49.
And then actually it becomes five yearly up until the age of 64. In Wales and Scotland, it's a little bit different.
So that's every five years right the way through. So from 25 up until 64.
What we do know is that screening saves thousands of lives every year. Not only does it detect cancer early,
but it can also prevent cancer. And you get your invite
for the national screening programmes automatically, just get sent to your house and that information contains some backgrounds
about what to expect and what's involved, together with the risks versus benefits so that you can make a weighted decision
about participating in it. Unfortunately, not all of the top five cancers
are included in those national screening programmes and I think the two big exceptions are prostate and lung cancer.
Now for prostate cancer, it doesn't mean that we don't have tests and investigations for it. It just means that those aren't specific enough
to detect prostate cancer when it's still asymptomatic. For lung cancer, actually the NHS since 2019
has been offering some early lung cancer checks and so it's worth checking with your GP
to see what's available and where it might be available locally. Thank you.
And I think sometimes people get a bit confused with screening and what it means. The purpose of screening is to detect
abnormal changes before there are symptoms. Sometimes people say to me, well, I don't have any symptoms so I don't need to go.
You do, you do. And actually if you do have symptoms, then the screening tests aren't the correct test for that anyway.
There are different tests you should be having. So I think the key message is, if you receive that invitation for screening, do it
because it might just save your life. Completely. And it's really important that if people are attending best screening appointments
and they're receiving the all clear, that's fantastic news. But they should still be really vigilant if something doesn't feel right in between
and still follow those bits of lifestyle advice that we discussed earlier because all of that will reduce
their risk of developing cancer. Okay, so while screening's great and really important, we know that still a lot of people don't do it.
So we ask Bupa customers why they might not get checked for symptoms if they have them,
but also why they might not attend screening. And so many people said that they didn't wanna see a Munchahypochondriac
or they didn't wanna bother the doctor. How would you respond to that? I mean, I think that's quite sad
that people feel that they can't bother a doctor. I know that there's lots of publicity at the moment about how doctor's busy, how busy doctors are
and how difficult it is to get an appointment. But actually, that's our job.
Our role is to be able to help you and that help can come either by reassuring you
that there's nothing to worry about, or by saying actually these symptoms are something that we should investigate further
and helping you to organise that. Yeah and I can say as well as a GP, I would be so upset if somebody was sat at home worrying,
concerned when it might not be cancer or even worse, letting something get worse and presenting later
when they could get it checked. No doctor in the land is ever going to be crossed or think you're wasting their time
if you think you have something that could potentially, possibly be cancer. So pick up the phone.
So the message is, talk to a healthcare professional, talk to your doctor if something doesn't seem right
or even if you just get that feeling something's not right 'cause that can be quite important, can't it? Trust your gut instinct on this.
Yeah. Some younger people might be worried that doctors won't take them seriously because of their age,
but equally it's really refreshing to see young people, I think taking more of an interest in their health
than before. Lots of people wear devices, people are interested in their data, people are engaging with their health more and more.
So what would you say to people who feel maybe that their docs might not take them seriously?
I think it's really important that people feel like that they don't have to be an expert
in order to tell a doctor that they're worried about some of the symptoms. You wouldn't necessarily expect
that if something went wrong with your car, you'd have to be a mechanic to go to the garage. So I always try to break it down for people
that they should just be able to explain their symptoms really simply. So if you've got a new pain for example, when did it start?
When is it happening? Is it happening when you are eating, walking, sitting, even at rest and how often is it happening?
Is it happening at night or is it just during the day? You know, those really basic things. And I think that if people are struggling to pinpoint
when and how their symptoms are coming on, sometimes keeping a diary is really helpful actually,
just writing it down. That sort of information is really helpful as a doctor because actually it can prompt a line of questioning
that maybe new and it can really help us to get to the heart of what the problem is.
I always say to people as well, don't be afraid to tell it. Help us if you because you might have a set of symptoms
that the doctor actually doesn't associate with cancer, which is great 'cause that means it's probably not.
But if you are thinking it, don't be afraid to say to your doctor, I've been really worried about this because I've been thinking it could be cancer.
Don't be afraid to use that word. And then at least then as the doctors, we know that's what you're thinking.
Like you say, it might take you down a line of questioning and hopefully, that will result
and has been able to at least put you ease and reassure you and tell you the reasons why we don't think it is. Yeah, 100%.
But we know that people under the edge of 35 can absolutely get cancer as well so take it seriously.
The final point, many customers told us that they find it difficult to get an appointment
to see a GP about their concerns at the moment. And I think we do have to address that.
Again, I would respond to that. If you're thinking it's cancer, please let us know because that would be prioritised.
But as a Bupa customer, if people are worried, they don't actually need to go to their GP, do they? They can go directly to Bupa.
Yeah, that's absolutely right. So patients who are worried about cancer can call our director access team.
And it's a couple of short questions with one of our specialty trained advisors. There's no claims impact for those questions.
And what we do is compare the symptoms that they're experiencing with national guidance. And if the threshold of that is met,
then Bupa will refer you directly to a consultant of your choice. I think, if that's not the right avenue for people,
then there's also the digital GP service, and that will allow you to speak to a GP
and to be able to see the right person first time around. And I think for people
who really want urgent clinical advice and are really worried,
then anytime healthline nurses are also available 24/7. So you can call.
If you are waking up in the middle of the night worried about it, we're here to help. Specifically for skin cancer,
we have a skin cancer remote pathway where we are able to do an assessment and either reassurance
or a referral if we need to or from the comfort of people's own homes. So, I think with all of those options,
I really don't want people sitting at home worrying about it because there's so much help and advice out there.
We are really here to help. Rebecca, thank you so much for that. Absolutely right.
There are so many ways that people can get help. So hopefully, that's really empowered everyone at home
because nobody should be sat at home on their own worrying about something being cancer that probably isn't.
But if it is, really needs to be addressed as soon as possible. Okay, so Rebecca and Tim,
we're gonna do one of my favourite activities to do as a doctor now, and that's a bit of a bit of medical myth busting
in the context of cancer. So first one's for you, Tim. Supplements and super foods can reduce my risk of cancer.
Okay, I suppose first of all, what do we mean by super food? We're talking here about a food that has been identified
as having high levels of something, the X factor, whether it's a vitamin, a mineral or whatever.
And yeah, we do know that there are some foods that can prevent you getting some illnesses. Foods that are high on our end for example,
can help prevent things like anaemia. But there's no evidence at all that any particular food can protect you
against any kind of cancer at all, unfortunately. Again, it comes back to being sensible,
eating a healthy, balanced diet, all the main food groups in it. Nothing too excess.
Be sensible. If you're worried at all, again, just seek advice. Rebecca, I'm getting older now
so I don't need to worry about cancer. Well, unfortunately most types of cancer
do increase as we get older. And as we previously discussed, about one in two of us will have cancer
during the course of our lifetimes. And that's because as we age our cells accumulate damage
and sometimes unfortunately, that damage can result in us developing a cancer.
The common cancers as we get older are breast for women, prostate for men, colon, rectum, skin and lung cancer.
I think it's really important for us to remember that just because you're getting older
doesn't mean that you are definitely going to get cancer. But also those lifestyle factors that we have spoken about before,
actually that's an opportunity. It means that we can reduce our risk of developing cancer regardless of our age.
So, I find that really heartening. Perfect. The next myth for you, Rebecca.
Cancer will always return. Not necessarily, but it is possible. And I think that that's why as doctors
we talk in terms of remission, not cure. I think it's really important for people
who have had a cancer diagnosis or have a family member who have been diagnosed with cancer to remember
that every day in remission reduces that risk of recurrence.
And for most cancers, if they're going to come back, they're going to do so within either the first two years
and even less likely within the first five years. And after that, literally day by day the risk goes down.
I think after 10 years for some types of cancer, actually, doctors are confident enough to say
that the cancer has been cured. But just because the risk of recurrence is going down,
that doesn't necessarily mean that the mental burden gets any easier for patients. And I think we just need to be really sympathetic
about how stressful it is on people. I think that's something that our nurses are really good at Bupa,
understanding the kind of long term impact of a cancer diagnosis, even years down the line.
Patients need to be listened to and supported and potentially directed to the right information and resources.
So that's something that we're keen to do. That's really helpful. The next one again for you Rebecca is,
I don't smoke, can I still get lung cancer? So firstly, if you've never smoked, that's fantastic news.
Well done. I think smoking doesn't just increase
your risk of lung cancer, it increases your risk of heart disease, of lung disease and strokes, for example.
I think it's a slightly complicated question firstly because there are some really rare forms of lung cancer
which can occur in people who've never smoked. And also, people who've been exposed to other people smoke,
so called passive smoking can be increased risk of lung cancer
even if they've never smoked themselves. And that's really because the chemicals and cigarettes smoke
impair the cells ability to repair themselves. And so you get this accumulated damage that we've spoken about before
and in certain cases that can lead to cancer. Smoking overall does increase your risk,
not just of lung cancer but of throat and mouth cancer and actually of all cancers.
But if you've never smoked, that's fantastic. It reduces your risk of developing all of those.
But it's still really important to attend your screening programmes and to lead a healthy lifestyle,
and to be on the lookout for any of those kind of worrying signs or symptoms that we've already spoken about.
And I think a persistent cough that you don't know why you have it, is unexplained.
Even if you're a non-smoker, even if you've never smoked, still needs to be checked out.
One for you Tim. Young people don't get to cancer. It's true to say
that cancer generally is more common in older people, but it's by no means unheard of in younger people.
One of the big concerns for us as doctors at the moment in younger people is melanoma skin cancer.
That's probably the commonest cancer in people under the age of 35. And that's really down to excessive exposure to the sun,
inadequate protection from the sun. So that's something that you really have to be careful with. Younger people, children in particular,
are more prone to some of the blood cancers and things like leukaemia and they can be difficult, again to diagnose and that they can be things
like recurrent infections or tiredness. And again, if you're concerned about your child,
if you're a young person, you're concerned that things don't feel quite right for you, again, seek advice.
But unfortunately cancer can happen at any age even though it's far more common as you get older.
And there are some cancers that are actually common in young people. So you spoke about, in children leukaemia
but also testicular cancer is actually rare in older people,
much commoner in younger people and cervical cancer as well. Yeah, that's true. And testicular cancer can be a particular problem
because obviously as boys are growing into young men, there are changes there anyway. And the concern is,
you just think that's part of a normal change with age. If you find that your testicles are growing unevenly,
don't just assume it's age, get it checked out. Cervical cancer particularly. Although we've spoken about the age
that the screening programme kicks in. As we said, the screening programme is not for people with symptoms of cancer.
So if you're a girl from your teens onwards, if you have symptoms that aren't normal for you,
don't assume it's just your hormone settling down. Again, get things looked at and get everything checked out.
And I think again it reminds us if you have that, just that gut feeling, something's not right,
whether you are a parent of a child or you're a young person yourself, tell the doctor.
Tell 'em what you're thinking and if you have to be persistent, be persistent because cancers do happen in young people
and they can be quite difficult sometimes to diagnose. Okay, well thank you both for that.
I love a bit of myth busting. I always think it's just really interesting and I think hopefully helpful
for the people out there as well. Which reminds us as well that no question when you're speaking to a doctor is silly, is too small,
it's too out there, just ask it. And that leads me onto some of the questions that we've had submitted by our viewers before this event.
So question for you, Rebecca. I know there's a link with genetics and some female cancers.
Is it the same for some men's cancers? It's the same to a certain extent for male cancers
and particularly for for breast cancer in men and for prostate cancer. But depending on the gene involved,
actually the risk is a bit lower. What we'd say is that if you have a close male relative
who's been affected by cancer, then it's definitely worth discussing it with your GP
if you are worried about your own risk. And I think what people need to be aware of is,
if they feel that they have a genetic risk associated with the family to be aware of the science
and symptoms of that particular cancer just so that they can be on the lookout for them. Okay.
And when you say a close family member, you mean first degree relative, so that would be a parent, a sibling, or a child?
Exactly. Okay, next question, Rebecca. I'm 35 and my dad's recently been diagnosed with prostate cancer.
What can I do to protect myself? So unfortunately, there's no way of preventing prostate cancer.
I think there are ways that you can reduce the risk. So there's some recent data that's come out
to show that if you're overweight or if you're obese, you are more likely to be diagnosed
with an advanced stage of the disease, unfortunately. So it's really important
that you try to maintain as much as possible, nobody's perfect: a healthy diet, maintain really good activity levels,
just so that you can try and stay within that healthy weight range. I think also really important
to be aware of the science and symptoms of prostate cancer. And that's particularly true
of a change in the way that you urinate. So not being able to urinate in the same way that you used to be able to and blood in the semen or urine.
Both reasons to go and see a doctor. For prostate cancer, if you have a first degree relative
with a history of prostate cancer, and by that we mean a father, a brother, a child for example,
then we know that you are at a slightly increased risk of developing prostate cancer yourself. And that's definitely worth
going to speak to your GP about to get checked. Okay, next question I have is,
how do I talk to somebody if I'm diagnosed with cancer? I think that could be a really difficult conversation
to begin with. I think the main thing is to just start talking.
Doesn't really matter what you say. I think it's likely that you're gonna have lots of questions
and my advice is to write them down. I think that's a good place to start
to identify what's important to you, where you might start to find some answers to them
and also might help you to signpost to the best place to answer them.
It might be a family member, it might be a close friend, it might be a health professional or it might be a charity. There's so much advice out there.
I think one thing that I'm really proud of at Bupa is that our nurses are really good at that.
So we have a specialist support team of nurses who are there to listen,
but also to be able to work through you what might be important for you and support you in the right direction
for where you can get some answers. That's really helpful. And how do I talk, support somebody with cancer?
I mean, I think, it's important to remember that not everybody wants to talk about it.
So my recommendation would be that you just start by acknowledging what's happened and then saying that you are free and willing
to listen to whatever they want to talk about, actually. I think lots of people are really hesitant about
talking to somebody about it directly because they feel like they have to be an expert in it, that they have to know all of the answers.
Actually, it's just about supporting somebody's journey, and they may want to talk about anything other than cancer.
So it's just about being able to join them and hear what they have to say
regardless of what that's about. I think I'll be afraid to ask as well or let them know. If you just say to somebody,
I don't wanna overstep the mark here, but you let me know how can I support you? How can I be there for you?
And just letting them know that that you're there. It might be that they say, oh, actually I don't wanna talk about it, but I would love to go out for a walk on Sunday
to our favourite spot or whatever, so, yeah, okay. Tim, couple of questions here for you.
I've been on the contraceptive pill for 20 years since I was 16. Are there any links to an increased risk of cancer?
This is an interesting one because there were a lot of reports in the media a few years ago, which I think scared a lot of women
about possible cancer risk associated with the pill. Yes, there is a very slightly increased risk
of breast cancer if you're taking the traditional combined oral contraceptive. But to put that in context,
maybe one in a hundred cases of breast cancer can be shown to be linked to taking the pill.
Eight in a hundred cases of breast cancer are probably linked to obesity. So that puts it into context.
The other thing to remember is, even if there's a slightly increased risk of breast cancer,
the pill actually protects you against ovarian cancer and cancer of the womb. Now breast cancer, as we've discussed,
there are screening programmes. It's relatively easy to detect early. Early detection means better treatment,
means better survival. Ovarian cancer and womb cancer, harder to detect.
There's no screening programme, if they're detected later, survival is worse. So actually, if you look at the risks and the benefit,
the benefit from being on the pill outweighs the risk. What I would say is, over the last 20 years, your body might have changed,
the types of contraceptive, the available might have changed, your life circumstances might have changed.
It's probably not a bad time to just have a word with your doctor or your family planning professional and say,
is this still the right thing for me? Absolutely, brilliant advice. A close friend recently died of ovarian cancer
and had very few symptoms. What should I be looking out for? This is another difficult one because as we've said,
ovarian cancer can be very difficult to diagnose. The symptoms of ovarian cancer
can mimic lots of other conditions. But we're looking at things like unexplained abdominal pain, bloating,
feeling full up when you haven't eaten, change is actually in bowel habit and the way you pass urine
can be affected by ovarian cancer, tiredness, unexplained weight loss,
all the things that we've mentioned as rather vague symptoms. But again, this is all about understanding you
and how you work. If you hear a funny noise in your car, you go to the garage, if you don't seem to be working properly,
you need to get that checked out and seek advice in it. And is it, it's partly due to the location
of the ovaries, isn't it? If you have a breast cancer, your breast on your body, you can examine your breast,
there's a likelihood you might detect a lump, skin cancer if we can see our skin, testicular cancers.
Again, but things like ovarian cancer, pancreatic cancer, cancer with the gallbladder,
those organs that are deep inside the body, we can't access them. There aren't screening programmes. So unfortunately, is that one of the reasons
why they do tend to present at a later stage? Well, absolutely. And also again, because the symptoms are so vague.
So people are gonna say, oh, it's indigestion. It's the time of the month, I always retain fluid.
These kinds of things, which that may be perfectly true, but actually you don't necessarily know unless you can get checked out.
And if it's happening all the time and it doesn't seem to be obviously related to food all the time of the month, then please just seek advice.
And then I guess my question from that is, how do we then maintain that balance? Because
the danger is that every time people get a bit of a funny tummy symptom or feeling a bit tired,
you can start to worry that it's cancer. Is it more about looking at the pattern that things tend tend to not get worse and better,
worse and better, but gradually get worse? Or how else can people identify when they should be worried
versus when actually if it's just sort of common things like tiredness, it might not be so worrying?
I think it's important as you said, identify patterns, keep a diary.
When does this happen? Is it associated with meal times? Is it associated with sleeping in certain positions?
Is it associated with exercise? Do things seem to be getting worse under gradual decline?
But again, if you can seek advice and get an explanation for what is going on, then that can actually put your mind at rest
as much as anything else. And you then have an explanation for those symptoms. And there are tests, aren't they?
Available as well, which can often be very helpful. Why might I be offered chemotherapy and not radiotherapy?
There are, as we've said before, 200 or different kinds of cancer.
They're treated in different ways. I mean, there's a very broad rule. Radiotherapy because it involves
exposing the cancer to radiation, tends to be confined to cancers, are localised in one part of your body.
Chemotherapy because it gets into your system and can spread right around the body, is more commonly used for cancer
that's spread around the body or things like blood cancers. However, chemotherapy works very well
for some localised cancers like bowel cancer even in the early stages, breast cancer in the early stages
and sometimes it's used together with radiotherapy and sometimes both are used together with surgery.
So it's very much about what's your cancer type? Have you had other tests that suggest
that you may not tolerate chemotherapy very well? Have you had radiotherapy to an area previously?
Which means you can't have radiotherapy twice to that area? Are there other reasons why you can't have it? Is your general health so poor that you wouldn't tolerate
a long course of radiotherapy, for example? So again, talk to your specialist,
write things down, know the questions to ask, talk to the cancer nurses,
people like McMillan Cancer Support, the cancer nurses at Bupa, or all of these people can help you
to answer the questions that you've got. Yeah, I think sometimes it's just making sense of that, isn't it? Because these decisions are often not straightforward.
And I dunno if people know, but often we have MDTs or multidisciplinary team meetings where you'll have lots of different experts all in a room
all discussing your case based on things like, the type of cancer, the specimens that they've taken,
the histology, how that looks. Also, how healthy you are, how fit you are and what your preferences and what your life is like.
And often, that team together will put their heads together and come up what they think is likely to be the best plan
and they'll present that to you. So specialist nurse will be the perfect person to help you sort of make sense of all that.
And the specialist nurse is also your link into that team because he or she will know what your preferences are
and they can be fed into the team. Thank you. And then we have one more question.
I'm due to start chemotherapy next month and considering trying the cold cap.
My hair is shoulder length and very fine. Is it worth trying? Should I have it cut before starting?
So what is the cold cap? And this person wants to know if they should try it. Right.
Chemotherapy targets cells which are growing and dividing very quickly,
which is what cancer cells do. Other things that grow and divide very quickly are hair cells.
So I'm sure a lot of people are aware that chemotherapy treatments can make your hair fall out.
Not all chemotherapy, but some. What has been found is that if you can cool the stout down
to pretty low temperatures, you almost put the hair cells into suspended animation so the chemotherapy has less of an effect on them.
Doesn't work with all kinds of chemotherapy so you need to know whether the chemotherapy is suitable.
It works for any hair type. It's not a good idea if you suffer from things like recurrent migraine
because basically it gives you an ice cream headache and if you already suffer from migraine, that's not something that you want.
But again, actually, if you're able to tolerate that, then the cold cap maybe a few weeks.
Again, discuss it with your oncologist, discuss it with your specialist nurse. So I guess that's the thing with the cold cap,
it's about like everything when it comes to cancer, asking the questions, being informed that you can make your decisions.
I think the other thing with the cold cap is, if you do try it and it's too uncomfortable, you can always take it off.
You're not committed to wearing it for every treatment after that. Thank you, Rebecca.
Thank you, Tim. Thank you so much for sharing your wealth of knowledge with us. And I really hope that that's empowered our viewers
to take care of your bodies, be vigilant, attend your screenings. And if there's anything that you're worried about,
then get it checked out either with your GP or by contacting Bupa.
Inside Health:
Female cancers
Symptoms | Screenings | Lowering your risks
Watch in 1 hour
Hosted by TV’s medical presenter and NHS GP, Doctor Zoe Williams and joined by a panel of Bupa experts, they discuss all things female cancer related – providing tips and advice to help reduce your risk.
Huge welcome to everybody, and thank you for joining us for this event. My name is Dr.Zoe Williams, and I'm an NHS GP and a media medic.
So this is the first virtual event from Bupa as part of their Inside Health series, and it's an exclusive event that's just for Bupa customers,and a chance to get insights and valuable advice directly from the expert team at Bupa.
As March represents Ovarian Cancer Awareness Month, we thought that this was the perfect opportunity to talk not only about ovarian cancer, but all things female cancer, exploring the symptoms to look out for,the regular checks and screening options available to you, as well as the impact of age and menopause, etcetera.
We've also received hundreds of questions from yourselves, so thank you again for that, and we'll be sharing some of these questions with our panel,
as many as we possibly can, right at the end of the event, so do stick with us until the end. But first up, we're going to be speaking to Nicola, who’s a Bupa customer, and we're going to hear all
about her personal experience with cancer and what learnings from her journey she can share with us today.
We’re then going to be joined by Dany Bell from Macmillan Cancer Support, who's going to be telling us
about the different avenues of support available to those who are currently dealing with cancer,
either directly or perhaps through a friend or a family member. And then after this, we'll be inviting our Bupa experts, including Dr.
Petra Simić, Dr. Samantha Wild, and Mr. Thomas End to join us in a panel discussion
on the topic of female cancer before answering all of your questions. Okay, so I really want to welcome
Nicola now. Nicola is a Bupa customer who was first diagnosed with breast cancer in October 2019, so that's about 18 months ago, is it, Nicola?
Yeah, it all started in about November 2019, and it's been a very long 18 months but it's come to the end, and I'm very grateful it has done
Excellent news. What I'd love to do is invite you to talk us through your cancer
journey from diagnosis to your current treatment plan.
So in January 2019, I had a clear mammogram, which was great news, what every woman wants to hear.
And then in September, the NHS asked me if they wanted me to join their screening programme.
And I ummed and ahhed, and I thought, “Hm. I don't know, because I've just had a clear mammogram, and do I really need to go ahead and have another mammogram?” But something made me do it, and how lucky was I
that I did it because that mammogram, it identified I did actually have DCIS.
which was precancerous cells, and that I would need further treatment. And I was so happy that I had identified it
really early and I had caught it early, and I was very fortunate. But then I went ahead and had the lumpectomy,
and after that the doctor then said, he explained that it wasn't just DCIS
There was also an invasive element in it. And so I'd gone from precancerous cells to full on cancer,
and that just changed everything in the whole journey that I had ahead of me.
and because he hadn't got wide enough margins, the surgeon said I had to go and have another lumpectomy, so I went ahead and had that.
But still, even after that, they still hadn't got clear enough margins,
but I had to go ahead and have my chemotherapy, so I went off and I had 12 weeks of weekly chemotherapy,
which was pretty gruelling and very tiring, but I got through it.
And at the end of it, I then had to go back and see the surgeon, and we had to talk about should I have a third lumpectomy or should I have a mastectomy,
and it was a big decision. The lumpectomy seemed relatively easy and straightforward, but actually I just wanted to get rid of the cancer.
I wanted everything out, and so I decided, amongst other things other,
I discussed it with a lot of people, and at the end of that, I decided I would have the mastectomy, which is a pretty
brutal, tough operation to go through, but I felt that was the best decision for me in my cancer journey.
And I understand that actually during your cancer journey you had some complications due to the chemotherapy.
Was it due to the Herceptin? Herceptin is an amazing drug, but it can cause problems with the heart,
and so you are given checkups every three months to make sure that everything is going well.
And mine was going really well until after cycle 16 when they found out that I had a left ventricle problem,
so they told me that I had to pause the treatment,
and that would be a psychological blow to me because all I wanted to do was get to the end of my Herceptin and feel like I'd done it.
So they put me on heart drugs and monitored my heart, and finally the heart got strong enough again
so I could go on and complete all 18 cycles, which to me was a victory
.16 would’ve been fine, but 18, I just had to get there. I had to tick that box and I had to finish the treatment
Well, there's something psychological as well, isn't it? You are in a fight and you've utilised
whatever you have inside you to give you strength on this battle, on this journey.
And clearly for you, you have that finish line in sight, and in the same way that to run a marathon and then get a sprained ankle
and finish a hundred metres short of the finish line, it must be a similar sort of feeling. You must think, “Oh, I'll do whatever it takes to drag myself all the way to that thing, that goa
lthat I've been focusing on that's been driving me and giving me strength.” And I wanted to ask a little bit
about your cancer experience has occurred in the midst of a global COVID pandemic
,and how has that impacted your treatment, number one, but also your experience of going through this?
One of the things I've been lucky about going through this, my treatment, is that, despite COVID and despite the pandemic,
I actually managed to finish all my treatment pretty much on time and on dose and have all my operations
.So that was a big relief, and I know many people haven't
,so I was lucky in that respect. But the whole experience did change, because when I started out going to chemo.
I had friends who came along with me and it was all a bit of a laugh. And when I had the cold cap put on, there was somebody doing reflexology for me,
and then I went to doctor's appointments and I had friends or family taking notes, and then I could discuss it with them and I could understand it
.And then of course, COVID hit ,and suddenly you weren't allowed anybody in a hospital with you,
which was quite understandable, but it meant you had to do everything on your own. But the staff at the treatment suite were amazing and they become your friends
and it was a day out and it was quite fun, still actually. And the doctor's appointments,
you just have to be more aware and take more notes. And now, Nicola, before I let you go, I'd love to ask you
what would your top three pieces of advice be to give to somebody who's perhaps just received a cancer diagnosis,
or even somebody who has a loved one who's going through this? I think the most important piece of advice is go to your screenings
on a regular basis. Don't miss any. And if you feel anything that's not quite right, go and see your GP, get it tested.
The earlier the diagnosis, the better the prognosis. Then I think
try and talk to other cancer patients and learn about their journey.
They will give you insights and understanding that no one else can give you. The next area is
just try and be positive throughout the whole journey. Find ways to make yourself laugh. And if you feel vulnerable, cry.
There's nothing wrong with crying. And finally, just try and own your journey.
Control it. Understand everything. Do the research,
ask the questions of the doctors, and feel like you are in control of your journey. We welcome it, because actually we might be experts in medicine,
but you are the only expert in you, so it's important that you see yourself as an expert as well.
Nicola, thank you so much for your time and for being so open and sharing your story with us.
We're really grateful. Thank you so much. Bupa Health
Clinics has partnered with the charity Macmillan Cancer Support to provide counselling to people with cancer who are struggling to cope emotionally.
And now, I really want to introduce with a really warm welcome Dany, who’s a strategic advisor for treatment, medicines, and genomics at the Macmillan Cancer Support
.So, Dany, thank you so much for joining us here today. To start off with, can you provide us with a bit of an overview
of Macmillan and the role that you have within the charity? Hi, yes.
Hi, Zoe. So Macmillan is one of the largest UK charities,
and we offer people with cancer support ranging from practical, emotional,
social supports, and we do that via a variety of channels. So we have our helpline, which is 24/7.
We fund posts like the famous Macmillan nurses, we have an online community, and we do things like the work that we did with Bupa.
So we have a welfare rights team to help people with financial problems, and the information resources that we have cover
everything really and are really easy accessible to people. So our aim really is to help
everybody to live the best life that they can when they've got cancer. Can you share any interesting facts or figures that would show the landscape
of female cancers and how it's been changing over recent years?
Yeah. So at the moment, 1.6 million women living with cancer,
and we know from looking at statistics that by 2030 that will be 2.2 million women.
We know half of those 1.6 million are living with breast cancer, and we also know, as of 2019,
cancer is the highest cause of death in women. What are the most common reasons that people seek support from Macmillan,
and what are the common types of questions and issues that your members come up with?
I think what I said at the beginning, in terms of people will struggle with a range of things from practical,
emotional, physical, financial at different points, so it's not just all around when they get diagnosed.
And so they will come to us around all of those things. I think we do get a high volume of queries when people are making decisions about treatment or going through treatment.
That is an area where we do get a lot of queries. But we know that people are massively impacted
financially, so we do get a lot of queries and sign posting from our support line through to our welfare rights team.
I think anxiety at different points is another issue, and emotional needs, which is again, through COVID,
why we looked at doing the work with Bupa, because we recognise that ordinarily cancer
has that impact on people, and with COVID on top, people's emotional needs
were increased. Yeah, we've actually seen that reflected. We’ve had a lot of questions coming through from our members for this event talking about the emotional
and the mental side of cancer, so the fear of cancer coming back or the worry of not recovering or panicking about returning to work, everything really.
So what type of help is available for these women? So, I mean, guess
it depends on the individual and how they like to engage in help. I mean, I think in terms of fear of the cancer coming back,
or any concern really, is to talk about it and seek help
in the right place that suits that person. So some people, very comfortable with digital, and we have
a huge amount of information in different formats on our website, so we have podcasts, we have an online community where people can connect
with people going through the same thing, and some people find that support really, really helpful.
And certainly I know through COVID a lot of people have found that a real lifeline.
Some people prefer to talk to someone, so they might pick up our support line
advice that way. So it depends on what the person needs. We have information and support centres that are
based in a lot of hospital trusts across the UK that people can just walk into
where we have trained people,
and some of those are put on virtual services, so we have been able to maintain a lot of our information and support services.
And we've seen a real surge in access to all of those support
channels, really, so we've had a 31% increase
to our support line this lockdown compared to the last one.
Over Christmas, we had 14% more calls than we normally have, and actually we've had a 40%
great hit to our website as well, so we know that people value
our trusted source of information and our specialist advisors. And I think for people out there listening who are potentially struggling,
as a GP, or as Macmillan’s services, Bupa services, we might not be able to fix all those problems,
but we're always here to listen and to guide you and do what we can to help. And nobody should suffer alone in silence.
Always reach out. I guess the final question for you, Dany, is around
we know that cancer doesn't just affect the person living with cancer. It affects everybody else around them.
What advice would you give people who were supporting friends and family members, colleagues through cancer?
I would say exactly the same to them as I would say to someone with cancer is
don't worry in silence. Seek help. Our services are available for people who are affected by cancer
as well as those people that are living with cancer. But equally, I think what a lot of people worry about
is talking to their loved one or their friend or when they've got cancer and they often don't know how to do it.
But I guess the biggest piece of advice I can give is they are still the same person and they need you.
And so just to still communicate with them, still do all the things that you always did.
And I know that some of that's virtual at the moment, but to stay in touch with them and ask them what support they need.
So I think you said it earlier, really, is to talk and talk together and
support them in the way that they need it. And access help and support from services like ours as well
who can give a lot of advice about how you support someone with cancer. Yeah. So those services are not just there for the person who has cancer, they’re there to support
family and friends as well. Davi, thank you so, so much for that lovely insight
into your world, but also for your incredible advice to people out there living with cancer and everybody else as well.
Thank you. Pleasure.
Having heard from our guest speakers, it's
now time to meet our panel of experts and we have three of Bupa's leading medical experts joining us here today
to talk us through female cancers and what we can all do to lower our risk. And we're then going to be putting your questions to our experts in the Q&A at the end of the event.
So please just stick with us. Throughout the panel discussion, we'll be running a few polls as well. So please do get your opinions and your thoughts down on those polls
and we’ll be sharing the answers with you as we go through. So our expert panel, we have Dr.
Petra Simic, who’s previously an NHS GP doctor for 10 years. Petra is now medical director in Bupa Insurance and she's passionate about shifting the stigma
surrounding many female health related subjects and wants to empower women like you with reliable information.
Dr. Samantha Wild, also a GP by background. Sam is the women's health lead for Bupa Health Clinics delivering health assessment and women's health
appointments. She has a vast amount of experience in female health, particularly in issues surrounding the menopause.
And Mr. Thomas Ind. Tom is a skilled gynaecologist. Over the years he's become an expert in complex surgery,
endometriosis, hysterectomy, colonoscopy, and of course cancer.
So welcome everybody. Thank you so much for joining me. We've got so many questions to get through, but to start us off, Petra, I wanted to ask you
about the prevalence of cancer and common symptoms that our viewers should be aware of.
So firstly, can you just provide us with a bit of an overview of the most common female cancers?
Well, thanks Zoe. And so important to be talking about this today. I think when people talk about female cancers, they often
think about cancers which affect women uniquely. And so people often expect that what we'll be talking about is ovarian
cancer, cervical cancer, endometrial cancer. But the truth of the matter is that the top three cancers in women
only figure in one of those cancers which we really think about, which is breast cancer. So breast cancer, lung cancer, and bowel cancer
make up 50% of all cancers that we see in women. So when we talk about female cancers, we need to be thinking about the whole of the female,
not just their reproductive or sexual organs. The top six cancers in women then include things like
melanoma, ovarian, and endometrial carcinoma, and so taken as a whole, those six cancers make up two thirds of the cancers we see in women.
Awareness of breast cancer in the last 20 years since I qualified has really, really increased and women are much more aware of their breast health.
But I would say it's quite interesting how unaware they are of perhaps their bowel health or lung health.
And they don't put it on the same importance level when they're thinking about their health and cancers in particular.
What are the early warning signs that women should be looking out for as an indication that there might be something wrong that needs to be checked?
And in particular, what might be the sort of very subtle or hidden signs that we might not pick up unless we're searching for them?
I mean, it's really hard to give a brief answer to this because there are so many cancers. The six I've just described all have different ways in which they present.
But I think there's a few things that you need to be really aware of. So I think understanding your own personal risk of cancer is quite important.
So I often have quite a lot of young women coming in to see me in surgery concerned about cancer,
but interestingly, the older women who believe their reproductive organs have kind of shut up shop and been mothballed
tend not to be worried actually about things like ovarian cancer because they have in their head,
well their ovaries have stopped working, so therefore they're not a problem. So I think the first thing is to really understand your personal risk.
And broadly the older you are, the higher your risk of cancer in general terms.
If you're a smoker, if you're overweight, if you've got a strong family history of some cancers that may increase your risk of cancer, but often not always.
And if you drink more than the recommended guidelines, these are all things that could increase your risk of cancer. So the first thing I say is know your own risks
and then know your own body. People are aware of their bodies
and knowing when there's a change and that's unusual for you. But importantly, persistent changes.
So if we were to talk about bowels for example, many people's bowels change all the time. It depends on what they've eaten, how stressed they are, how much exercise they've had, how much water they've drunk.
Their bowels can fluctuate and change hugely, but as GPs, what we are interested in is a persistent change in normal for you.
And broadly that applies to most cancers. And probably the most worrying symptom that worries all of us as GPs
if someone has persistent unexplained weight loss, that's one of the things that probably universally I would say, is one of those things
that should not be happening and definitely needs to be checked out.
But then there's the skin lesions that aren't healing or unexpected lumps or bumps
or growths and particularly if they're growing over a short period of time. As we get older, we often gain nice little skin tags
and extra moles and warts and little added bits, but things that grow over a short period of time, it's really important to get those checked out.
Fantastic, brilliant answer Petra. A lot of the viewers have been sending us questions and there's been a real, we've noticed a real focus
on ovarian cancer and we know that ovarian cancer is one that we really worry about
because it tends to present late because the symptoms can be quite vague. So can we dig down a bit deeper into ovarian cancer?
What are the specific symptoms that we should be looking for, we should be looking out for?
What clues might there be that something's wrong? So I mean ovarian cancer is one of those cancers as a GP you most dread
because they're very difficult to find. So importantly with ovarian cancer is if you are young
and of reproductive age, this is unlikely to be a cancer that's going to affect you. Never say never, but really it is, this a cancer of postmenopausal women.
And what we think about is women who have a change in bowel habits. So interestingly, people think about ovarian cancer, they don't think about their bowels,
but actually what's happening to your bowels can be one of the symptoms that are linked with ovarian cancer.
Even to the point of things like indigestion and difficulty eating. So your whole digestive system can be affected.
Abdominal bloating, again, not very specific because as you get older it can be easier to gain weight, particularly in the middle.
But that bloating feeling and women often remember it from when they were say premenstrual, that it feels uncomfortable
perhaps almost like when they were pregnant, that they feel that fullness. So a kind of fullness, sometimes urinary symptoms.
I think the hard thing Zoe, is that so many of those symptoms could be characterised as getting old or having urine infections or irritable bowel syndrome, that it's incredibly difficult.
I think what I would say to women out there is be aware of ovarian cancer
and if you're having symptoms that don't seem right, particularly related to digestion and bowel,
even if your doctor is going along the lines of looking into your bowel, ask them about your ovaries.
Have that conversation because it can be really easy as a GP to get very much down the line of
they have a bowel problem, I must look into their bowel problem to just stop and pause and think that maybe I need to scan their ovaries and check they're okay.
So it's an awareness piece that the ovaries aren't doing their reproductive job but there may be affecting other organs.
And like I said, don't be afraid to say to your GP, could it be my ovaries?
Because I heard that bloating actually can be linked to ovarian cancer. Never be afraid to say what you think it is and never be afraid to use the C word as well.
It's not a dirty word. And as doctors if you say I'm worried it could be ovarian cancer, that might just be the thing
that is required to light that little memory pathway in the GPs brain to do the tests that are available to us.
Tom, what type of abdominal pain might you expect to get with ovarian cancer?
Because there are so many different types of abdominal pain and where would you expect to feel it?
I wouldn't say there's any one particular type of abdominal pain that's more common than others.
I've seen three cases of ovarian cancer this week already
and they were all presented in very, very different ways. Most women have had symptoms for months and months and months.
And the reason general practitioners worry about ovary cancer is the chances of them having had a medical appointment
with someone between when they first developed symptoms and when being diagnosed is quite high.
And a lot of people get gastrointestinal investigations. Irritable bowel syndrome is a very common diagnosis.
But I think one of the points that Petra brought out early on is that this is very rare in young women.
It is something you see in postmenopausal women. It isn't actually one disease, it's actually lots of diseases
and you can actually get ovary cancer with normal ovaries on scan because really the disease is
fallopian tube cancer and ovary cancer and something called peritoneal cancer. It's all the same disease. Great. Thanks Tom.
So yeah, so with ovarian cancer, really important to constantly have it at the back of your mind, particularly in postmenopausal life.
But there are some cancers that we really can make sure we're doing everything we can at home to detect so we can do home checks.
Petra, can you tell us a little bit more about how we can do checks at home to potentially pick up female cancers?
Sure. So the two probably main things are checking for breast cancer and skin cancer would be the two things that you're most able to do because they are kind of looking and touching thing.
And so for breast health, really again, very important to know your own body.
So to get really familiar with what your breasts look like and what they feel like. And the best time for women to do that is often when they're about to jump in the shower or jump in the bath.
So take a moment just to pause and look in the mirror in your bedroom or bathroom just to see if your breasts look or what they look like if you're not really familiar with them.
But to make sure there's been no changes in appearance. And the kind of things we want to know about as GPs is, does it suddenly look uneven?
It's not the same shape as before. Normally that would be on one side more than the other. Is there any dimpling?
Are there any skin changes around the nipples? Sometimes eczema over the nipple can be a sign of something
more worrying going on deeper within the breast. And then what I tend to recommend women do is just get familiar with how their breasts feel often.
So we all wash on a regular basis. That's a really good time to feel your breasts and know how they feel
because especially with the water and the soap, it's a really smooth surface. And I tend to recommend people think about, when they think about examining
breasts, women often worry that they don't know how to do it. And actually breasts can be hard to examine.
They’re glandular tissue, they're not smooth, they're not meant to be smooth. And if you feel them with kind of a poking motion, everyone's breasts will feel very uneven.
So it's about imagining that you've got, I try and tell people to imagine a kind of Ziploc bag of jelly and you've hidden a marble in it and you're trying to find the marble in the jelly.
You wouldn't go like that because you'd keep losing it. What do is you’d press it against a flat surface and run your hand.
So it's the same kind of process with examining your breast, pushing the breast tissue against your chest wall with the flat of your hand.
And what I try and reassure women is that if there is something abnormal there that is very worrying, it's highly likely you might find it because they're not very subtle.
So it might feel like a small hard pea or a cherry or a stone.
The kind of lumps we expect women to find are quite different from normal breast tissue.
But if you find anything that makes you worried, even if it's the same both sides, then come and see the GP.
Let us examine you, let us have a feel. And sometimes it's a case of especially if you're still
having periods, come back after your period and we'll examine you again. But if there is a lump there, then absolutely we should be looking into that
with either a mammogram or an ultrasound scan and your GP should be making that happen for you.
And then mole checks, again, quite simple, looking at your skin, being familiar with your moles.
And when we’re thinking about melanoma, we're thinking about moles that change rapidly over a period of six to eight weeks, growing, crusting, bleeding
and being aware of that. Sometimes even taking pictures of it and then going back a few weeks later and taking another picture maybe with something to reference the size,
that can be a really good way of reassuring yourself it's not growing over that period of time. The same message, if you're worried, go and talk to someone else.
Share the worries and then you can explore whether anything else needs to be done. Okay, so some amazing advice there from Petra on the symptoms
to look out for and simple at home checks that we can all do. So I'd like to introduce the first poll now.
So this is to encourage all of you who are watching to participate so we can make it a live experience.
So we're going to run a quick audience poll and this will appear to the right of your video player.
And what we want to know is, when was the last time that you did an at home cancer check?
Was it in the last month, the last three months, the last six months,
the last year, over a year or never. So take your time, answer that poll, and the results will appear
live as we continue with our panel discussion. Another area of concern for our viewers was cancer risk and age,
and how to identify symptoms as our bodies are naturally changing with age.
So we're going to move on to Sam. And can you talk us through what cancers an older woman would be worried, should be worried about?
I mean we've already mentioned that ovarian cancer is one of them. And if there are any symptoms in particular that they should be looking out for, bearing in mind
there were so many changes that are going on in the body later in life as well?
I'd start by saying, as Petra just said, that all women need to be sort as aware of possible of all the different symptoms that they may experience with respect to different cancers.
So making sure that they’re as educated as possible. And also with regards to the menopause, again, reading up
about that, learning as much as they can, and knowing that there are sort of at least 34 symptoms that we know about and there will be some that overlap with cancers.
And so if they don't feel well, if they feel that things just aren't normal, to go and see their GP.
And as we said, we won't turn them away. We do know that a lot of these cancers do get more common as they get older.
The only one that doesn't is cervical cancer. And so it goes back to what we just said.
You know, don't think that because you are getting older, you're not going to suffer. So please go and see your GP.
Any bleeding after the menopause is not right. It should be checked out. And equally in the perimenopausal period when our bleeding might become a bit erratic, we would still say
if you had any bleeding in between your periods or after intercourse again go and get it checked out.
So I think again it's just reaching out for some help. If you feel that things aren't right go and see your GP.
Not all cancers have detectable symptoms early on. So we're very lucky in this country that we do have a great screening programme.
Sam, could you just give us kind of a brief overview of what the screening programme, what cancer screening we currently have available for women in this country?
When it starts, when it ends, and how frequently people would expect to be offered screening.
Okay. So we have three cancer screening programmes in this country. We have bowel cancer screening, which women may not initially think about.
They’re invited for screening between the ages of 60 to 74 every two years.
And actually I say invited for screening, but a bowel cancer kit is sent to their home. So they have a test that arrives in the post
and they need to take a sample of their stool, and then they send it off as instructed. And then they will get the results through from that.
We also have the cervical cancer screening programme, which starts at the age of 25
and is every three years until the age of 50, but then every five years until the age of 64.
And women are invited to attend to their GP surgery to have a smear test taken.
And then we also have the breast cancer screening programme, which is a mammogram that is done for women over the age of 50 until the age of 70.
And that is done every three years. And is there anything new on the horizon? Any new screening programmes we should be looking out for?
Any plans for screening for ovarian cancer that you are aware of? Yeah, Tom, would you like to elaborate?
Well, I think if everyone’s going to talk about new screening things I think the thing that's most exciting at the moment is the study that's just started a few weeks ago
on women taking their own smears. And there's a lot of data
already in smaller groups on self-sampling. And it's probably as good as, possibly even
better than a nurse or a doctor taking an HPV test. The problem
is that once it's abnormal you do then have to go and be properly examined. So for women who really can't stand
an internal examination, it's not really any good for them. Next, another topic that many of our viewers are interested in
is the genetic links when it comes to cancer. So as a surgeon specialising in gynaecological oncology,
can you talk us through which gynaecological cancers have hereditary links and how our viewers can assesswhether they may be increased risk based on their family history? So there’s a genetic association between ovary cancer
that everyone knows about because of Angelina Jolie, but there's also a genetic association with some uterine cancers.
And as we haven't discussed uterine cancer yet, maybe I should talk a bit about that. Because actually, uterine cancer is the most common female cancer.
I think people forget that. There are actually two main types of ovary cancer.
There's... Sorry. Two main types of uterine cancer. There's one that's definitely associated with diabetes and obesity.
And that's the one that’s sort of doubled in instance in the last 20 years. Now, that isn't associated with a genetic inheritance.
But there is one associated with this syndrome, which we call Lynch syndrome and it's also related to bowel cancer.
And we're beginning to understand that much more now. And everyone who's diagnosed with a uterine or endometrial cancer
will have staining of their tissue to see if they have something called mismatched repair gene staining, abnormal staining.
And if they do, they then go on to get genetic staining for this or genetic testing for this thing called Lynch syndrome.
And it's worthwhile knowing if you've got Lynch syndrome because obviously you can prevent against bowel cancer if you haven't been diagnosed with that,
and it would have implications for other members of your family. So uterine cancer has a very small association with
Lynch syndrome; about 5% to 7%. Then ovary cancer is classically associated with this single BRCA gene,
which Angelina Jolie had.
It's also associated with breast cancer. And your gynaecological oncologists will quite regularly be taking out women's ovaries
from about the age of 40 onwards in order to prevent them from developing ovary cancer in the future.
I think that's really interesting. And I think people who are watching this will be thinking, “If I have a family member who has had cancer, then
should I be undergoing additional screening, additional checks?” What about if I just have one family member versus I have multiple family members?
What's that pattern that you see in families that would make you think that you would be more at risk?
So for ovary cancer, having one first-degree relative,
and the first-degree relative is mother, father, daughter, sibling.
Obviously not father in the case of ovary cancer. But one first-degree relative with over cancer
would probably increase your risk by about 0.8% to 1%. So probably not enough to warrant having your ovaries removed because
that's the intervention that is done. So you've got to have quite a significant risk.
Certainly two first-degree relatives with either ovary cancer
or breast cancer under the age of 50 would probably warrant some kind of genetic consultation.
Now, the specialty of cancer genetics is a hugely expanding specialty at this moment in time.
And really you shouldn't be having any intervention to prophylax against over ovary or breast cancer without having seen a geneticist.
And you can have a series of tests done. Interesting. Thank you, Tom. I'm going to talk a little bit now about prevention and prevention advice.
And Sam, I'm going to come to you to talk about this. So I think looking beyond the checks that we can do, the self-checks and the screening,
what types of things can we all do to minimise our risk of cancer?
So I think there's six ways that I would say that we could tackle this. So the most important is to stop smoking.
That is the most preventable cause of cancer for all types of cancer; is implicated in 70% of lung cancer.
So definitely that would be my number one. Number two, try and reduce the amount of alcohol that you drink.
We know that that is implicated in a lot of cancers too. Try and maintain a healthy weight.
That's really important. Weight is implicated in the endometrial cancer as we've just heard,
but also breast cancer and bowel cancer as well in particular.
Try and have a healthy diet. Try not to stay in the sun too long. That will increase our risk of skin cancers.
So make sure that you wear some protection and you keep covered up, and you wear a hat and you don't go out at the times when the suns at its highest.
So midday. Avoid that midday sun and try and be sensible with regards to that.
And move. Move as much as you can. So exercise. We talk about the importance of exercise, not just to prevent cancers,
but also to reduce our risk of heart disease as well. There's so many benefits to that. So, ensuring that we do get out every day,
particularly at the moment as well when we're not getting out so much, make sure we go out for that walk, go out for that run.
And get some resistance exercise as well and just, yeah, keep moving. And what about diet?
So what are some of the specifics around diet? I mean, I think most people have an idea what an healthy diet is, lots of fruit
and vegetables, the whole grains, not eating too much sugar, too much process or high fatty foods.
But when it comes to minimising our cancer risk, are there any specific foods that we should be
completely avoiding or anything that we should be trying to consume plenty of to protect ourselves?
Yeah. There's no specific evidence to say that we should avoid certain foods or have more of certain foods at the moment in a particular type of food.
And we'd worry maybe that people would become deficient in certain nutrients if they did avoid food groups.
But as you've just said, having a healthy diet, lots of food and vegetables, high fibre,
trying to avoid some processed foods because we do know that that is linked to bowel cancer, and red meat as well.
So keeping that to a minimum, but making sure we get lots of those good proteins. So our white meat, our chicken, our fish, and our pulses
and that sort of thing is a lot better for us. And to dig down a little bit more into alcohol,
how much is too much when it comes to cancer risk?
So I think people would be surprised to hear that alcohol is implicated in seven types of cancer
and actually causes 12,000 cases of cancer a year. And I have a lot of women, and we’ll go onto this,
but are worried about taking HRT because of their breast cancer risk perhaps. But actually, when I point out to them that drinking more than 14
units of alcohol a week is even more risky, they are so surprised by that. So I think it is something that we just don't talk enough about.
So we do say for men and women to try and have less than 14 units of alcohol a week.
It doesn't matter what type of alcohol it is with regards to your cancer risk. And it also doesn't matter whether that's spread out or whether it's
sort of binge drinking as such when we're looking at cancer risk. I mean, it's obviously different in other circumstances, but from that cancer risk point of view,
it's just staying below that 14 units a week. Thank you. Great advice there.
So I'm going to introduce the second poll now and encourage all of you viewing to participate.
And this time we are going to be talking about lifestyle factors. So you should be able to see to the right of your video player where you can participate.
And the question is: What out of the main lifestyle factors
do you want to change to lower your cancer risk? The options are: lose weight, exercise more,
drink less, stop smoking, follow better sun safety, or other.
Sam, a great question for you. We've had lots of people asking questions. Does taking HRT put you at any greater risk of cancer?
And if there is an increased risk, dig down a bit further. Does it depend on the age you are when you start taking HRT or the length of time that you are taking it?
So yes, exactly as you just said. So there is evidence that HRT
can cause endometrial, ovarian, and breast cancer, but we must sort of stress that that risk is very small for most people.
And as you just said, it does depend on the age when you start taking your HRT, how long you take it for, and what type of HRT you take.
So for example, if a lady starts HRT under the age of 51, then when she’s taking that HRT she’s only
replacing the hormones that most women would still have naturally at that age. So her risk from taking HRT at that point is negligible.
It doesn’t increase her risk of developing those cancers. The risk kicks in after she has taken it
for five years over the age of 51. So that's really important and that's something that I have to go through
very regularly with my ladies in clinic. It also depends what type of HRT you take.
So when we take HRT, it's often the progesterone bit that's mixed with the oestrogen that is the worrying hormone that can cause that risk.
So if a woman takes oestrogen-only HRT, that doesn't increase her risk of breast cancer.
Now, it may slightly increase her risk of endometrial cancer if she still a has a uterus.
So in those ladies, we give them the progesterone as well and that will then decrease their risk
of endometrial cancer. And the risk of ovarian cancer is very, very small with any type of HRT.
It is negligible. They say about one in a thousand. It also depends on what type of progesterone that we give.
So the newer progesterones that we give these days, they are more natural, they're not synthetic.
And we have a very safe type of progesterone that we use now. It’s a tablet that can be taken at night.
It's called micronized progesterone, and Utrogestan is a common name for it. And studies so far have not shown that there is an increased risk of breast cancer with that type.
So it really depends what form a lady takes, what age she starts it, and for how long for. I think it's really interesting what you said
something women can really relate to is that this increased risk of cancer in most women is very, very small
and it can be compared to having an extra few glasses of wine per week that you should take.
So I always say to women, “You've got to consider your other lifestyle factors.” And if you're having a bad menopause, you're not feeling very well in yourself,
you don't want to exercise, you're eating rubbish food, you're reaching for that glass of wine, then actually by doing all of those and maybe not getting out and
getting that exercise that you should be, you’re just increasing your risk of cancers in that way rather than taking a tablet of HRT which will enable you to feel better
and therefore take better control of your lifestyle. And then HRTs protective as well.
It's protective against osteoporosis in younger women. Is it protective against heart disease?
I think that's another one that gets a bit confusing because at a certain age it’s protective, then at a certain age, beyond a certain age it's not.
Yeah. Exactly. So we tend these days... The studies show that if you start HRT soon enough, so if you start it within 10 years of your menopause
and under the age of 60, it looks like there is a protective effect on reducing that
risk of heart disease because our risk of heart disease goes up postmenopausally because our oestrogen levels drop.
That affects our blood vessels. It makes our cholesterol rise as well. What about if you have a previous history of cancer or a family
history of cancer, does that affect how safe it is for you to take HRT?
That's a really interesting question. It's quite difficult, again,
with some GPs and some doctors not being as educated as they should be these days.
I see a lot of women that have been told pointblank that, “ You've had cancer before, you can't have any HRT.”
It does depend on what type of cancer they've had. It It depends if they have had a breast cancer
or an endometrial cancer, whether that was one of these hormone receptive-positive cancers that, again, it makes a difference.
It's making sure that we know what type it was. For all those other types of cancers, people that have had leukaemia, for example, or cervical cancer,
bowel cancer, there is no reason why they can't have HRT. It may be that you need to speak to your specialist about that, or see
a menopause specialist, rather than just your normal doctor. We must also remember there's other ways to manage the menopause as well, so you don't
necessarily have to have hormone replacement therapy. There's other medications that we can use.
We can also use topical oestrogen for women that are suffering with what we call the genitourinary
symptoms of the menopause, so women that have dry vaginas, or urinary frequency, recurrent urinary tract infections.
There are other treatments there. One final question on this, Sam, what about women who have had a hysterectomy?
It is really important for these women usually to use HRT.
A lot of hysterectomies are often done in women under the normal age of the menopause. We know it's so important to replace those hormones that they would naturally have had,
as we've already said, to reduce their risk of heart disease, reduce their risk of osteoporosis as well.
Actually, if you've had a hysterectomy, you only need to have oestrogen-only HRT.
It's a lot safer in a way. You haven't got that greater increased risk of breast cancer.
It's negligible, if there is a risk at all. Any medication that you take is always going to have some level of risk.
I think people have developed some fear around HRT, and some people around the contraceptive pill, as well.
I think what's crucial, I guess, the advice that’s out there is make sure you understand
the size of that risk, because usually there's either no risk at all, actually, no increased risk, or that risk is so small.
It is comparative to having those two extra glasses of wine a week. Let's move on to the Q&A section, where we're going to get through as many questions as we can.
Firstly, thank you so much to all of the viewers out there. You submitted hundreds of questions.
Obviously we can't get through them all, but we'll get through as many as we can. Remember, if you have more general questions
about cancer, then do remember you can visit the Bupa Cancer Health Hub, where you'll find out information about different types of cancer and their treatments.
If you’re currently undergoing cancer treatment with Bupa and you have a specific question about your own treatment, contact your own Bupa specialist oncology team.
The details are being shown on your screen now. Panel, Sam, let's come to you first.
Can you inform women of colour of any specific cancers that they might be more prone to, and what signs and symptoms to look out for?
As not necessarily all cancers affect women from different ethnic groups equally.
It might come as a bit of a surprise, but there's actually a lower prevalence of cancers in the BAME groups.
What we find is that there is a poorer survival outcome.
I don't think it comes as a surprise to realise that that's probably due to some taboo, a cultural taboo, shame of talking about it.
Maybe some embarrassment as well. We know, unfortunately, that a lot of women may not be aware
of what symptoms that they should be looking out for. They may not attend for their screening as invited.
They also may not present to the GPs as they should as well. There might be some difficulties accessing GPs and getting listened to.
There may be language barriers there as well. I think studies also show that sometimes,
unfortunately, women of colour may need to present to their GP on more occasions than maybe a white counterpart would, before they actually get listened to and referred as well.
There's a lot of issues there. I think, as well, if you talk to women that have undergone treatment,
they may not necessarily feel that their needs are always catered for. There may be a little bit of lack of understanding about
things that may affect them culturally. They may also not be followed up as well, either.
We do find that women tend to present later with breast cancer, again, than their white counterparts.
We see that they’re twice as likely to present with late-stage breast cancer.
Also, cervical cancer is higher in women as they get older as well.
I think, again, that's related back to not going for their screening test, and maybe not presenting when they have got symptoms.
Thanks, Sam. That was a really comprehensive, and I think really honest answer as well, which brings up some topics that aren't often discussed.
Tom, next question for you. Do some gynaecological conditions such as endometriosis, polycystic ovaries,
fibroids, recurrent UTIs, do they increase your chances of getting cancer?
Let's start with fibroids, because that was the first one I remembered. About one in 500
to 600 fibroids become cancerous. Much more common in an older woman.
A woman with enlarging fibroids in the menopause,
that's the sort of person you have to think about for fibroids becoming cancerous.
Under the age of 40, it's very, very rare. If you have a fibroid, don't worry about it.
One in three women have fibroids. The only time you need to worry about it is when it's growing rapidly in size
and you're over the age of 45 and predominantly over the age of 50. There is an association with a type of cancer
called clear cell cancer and endometriosis. It's normally people who have very severe forms,
the most severe forms of endometriosis. It's quite rare.
I see a few cases, but they tend to all come to me.
It's more common in endometriomas in the menopause.
I wouldn't be worrying hugely about cancer if I had endometriosis. I'd be worrying more about the symptoms of endometriosis.
That's been a topic of great concern in our specialty, especially over the last few weeks.
Why women present less commonly with endometriosis. Why women aren't getting the treatment they should be getting
.It's become a bit of a political thing. I think we as a profession really need to up our game in the way we deliver care to women with endometriosis.
I wouldn't be worried about cancer. Polycystic ovaries, yes, because polycystic ovaries is associated with diabetes.
It's an oestrogen-dominant position. If you're someone with polycystic ovaries who is amenorrheic,
that means you do not have periods, then you are someone who is oestrogen-dominant.
You probably should be taking some progesterones to prevent the development of endometrial cancer later on in life.
The easiest way to do that is to go on the pill or to take progesterones, or to have the progesterone coil in.
There is a small association between polycystic ovaries and uterine cancer.
Thank you. Then recurrent UTIs is the last one. I’m not aware of recurrent UTIs being associated with cancer.
They might be associated with bladder cancer, but I'm afraid that's not really my area of expertise.
I would ask one of the general practitioners here who might know.
I think recurrent urine infections, especially if we can’t find a cause for it.
It’s not uncommon in postmenopausal women to get recurrent infections due to low oestrogen levels in the genital area.
If there’s no particular cause for recurrent UTIs, then that can indicate problems with the bladder,
one of which could be bladder cancer. Probably important to say that recurrent urine infections
are incredibly common, and way more common than bladder cancer. It’s one of those things that needs to be investigated.
Tom, is cervical screening still required following a full hysterectomy?
The answer to that isn't a straightforward yes and no.
There are two types of hysterectomy. Well, there are more than two types. You can have a hysterectomy called a subtotal hysterectomy, where the cervix is left behind,
and then cervical screening is absolutely still required. here is a type of hysterectomy where the cervix
is removed, called a total hysterectomy. Normally you don't need to have smear tests after that.
The exception is if when you've had your hysterectomy it is analysed.
If there is any pre-cancer in the cervix when it is analysed,
we normally do a smear of the top of your vagina at six months and eighteen months before discharging you.
Great answer. Anybody, if you still have a cervix, you must have screening.
We all know that when it comes to diagnosing cancer, the earlier the better,
because the earlier a cancer is diagnosed, the easier it is to treat, and the better the chances of survival.
Can you tell us a little bit more about that? How much difference does it make when it comes to the treatment
options for gynaecological cancers? For example, how might you be able to manage a stage one cancer versus a stage three?
You talked about stage one and stage three. I think possibly people wouldn't understand this stage thing.
Generally speaking in most cancers, stage one is a cancer that's confined to the organ that it originated in.
In cervix cancer, it’s when it hasn't spread outside the cervix. In ovary cancer, it's when it's just in the ovary.
In uterine cancer, when it's just in the lining of the womb. When a cancer has spread,
In cervix cancer, it’s when it hasn’t spread outside the cervix. In ovary cancer, it’s when it’s just in the ovary.
In uterine cancer, when it’s just in the lining of the womb. When a cancer has spread, if you remember, I said cancer is a disease of cells.
Cutting out the main cancer isn't going to cut out every cell. Then we're looking at other treatments, other than surgery.
I think that's all the questions that we have time for. Like I say, we had hundreds, but I think there's a lot of information there for everybody to take away.
That just leaves me to say a huge thank you. Thank you so much, Tom, thank you Petra, thank you Sam
for your expertise, for your warmness, and sharing your knowledge with us. I know I've learnt a lot, and I'm sure everybody else has, too, so thank you so much
.That concludes the event. That just leaves me to say a huge thank you to all of our speakers and also huge thanks to all of you
for sharing your questions, for taking part in the polls, and for tuning in. I hope you found it informative, and I hope you found it helpful.
Bye bye.
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