Cancer in women with mobility impairment
Malignant tumours affecting women can either cause mobility impairment or be found in a person with mobility impairment. Malignancy that can cause mobility problems, present as a tumour of the central nervous system or as a result of tumour, spread affecting mobility. I will focus on gynaecological tumours, so primary cancers include brain tumours or tumours of the spine.
Gynaecological cancers can cause mobility difficulty as a result of its spread to the nervous system or as a result of the effect on a person’s ability to mobilise.
Pre malignant lesions of the cervix do not cause pain and does not spread so here we have the ability to diagnose potential cancer causing lesions. The simple Pap smear is the way to diagnose abnormal cells and this can be treated and followed up in a way to prevent transformation to cancer. Research has proven that cervical cancer is positively linked to Human Papilloma Virus infection of high-risk subtypes. Testing for these subtypes can stratify those at higher risk and those with lower risk. There is a vaccine available in an aim to reduce the development of cervical cancer. It can be given to girls from as young as nine years. Malignant lesions unfortunately do not have symptoms in the early stages and therefore will only have symptoms when there has been spread. Pain, bleeding especially after intercourse, bladder problems, bowel complaints and movement issues will only present in the advanced stages. The problem with any advance cancer is treatment, and that has an impact on cure and/or long-term survival. In cervical cancer the spread is directly to organs and structures immediately next to the cervix and as a result of treatment women may have difficulties. The structures that may be involved include the spine and nerves, the renal system, intestinal system and less often the bones. Distant spread is usually to the liver and lungs and the impact on mobility may not be direct. Cancer in its nature can also cause blood clots in the vessels or clots that can affect the lungs, heart and brain resulting in difficulty to mobilise. Surgery is seldom used in advanced cancer and if used it is for comfort rather than cure and this can cause morbidity impacting on mobility and so too pain from disease or medical intervention.
Ovarian and Fallopian tube cancer:
In this case spread is also direct and often these tumours are not symptomatic until it is very large or start causing discomfort. Abdominal distension is often the prominent feature and can directly impact on mobility, and fortunately surgery and chemotherapy can be used to improve this. Ovarian cancer does not only affect the older women, but can affect young females.
Unlike cervical cancer ovarian cancer has no good screening test and a high index of suspicion is the only way to diagnose it early. All older women with regular complaints of non-specific gastro-intestinal symptoms should have an ultrasound to exclude ovarian growths. The women at an increased risk are those with a positive family history of ovarian cancer, stomach/bowel cancer, and especially breast malignancy, proven genetic mutations, and infertile women and those who may have used assisted reproductive techniques to conceive need to be carefully monitored.
None of the genital tract tumours have early spread or metastasis to the brain and depending on stage and type of cancer may we find significant morbidity. Associated conditions effecting the development of uterine cancer include obesity, hypertension and diabetes, which often affect mobility itself. This then increase the risk of other complications, like deep vein thrombosis, pulmonary embolism and concomitant infections of the bladder and especially the chest starting a cycle difficult to manage. Less commonly do uterine tumours present with an enlarged uterus and in these cases it can cause compression symptoms that may make mobility difficult.
Vaginal and labial cancer:
Fortunately not very common, but associated with significant morbidity and mortality. The best way to prevent development of these cancers is to know your body and if there are any ulcers associated with pain or a discharge need to be assessed and possibly require a biopsy. Evidence suggests a viral infective cause, but meticulous hygiene also decreases the risk.
Due to the location it is often allowed to grow without being assessed and presentation to a gynaecologist is delayed. This impact on the ability to cure. Healing after surgery will be influenced by general condition and possibly level of lesion. Advanced disease requires radical surgery and may risk complications secondary to immobility.
Mobility impairment does not influence the development of cancer, but because of loss of sensation and sometimes constant pain be missed and only be detected when it is advanced. Then treatment becomes more difficult and the risk of complications developing more likely.