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Cancer is a group of diseases in which cells are aggressive (grow and divide without respect to normal limits), invasive (invade and destroy adjacent tissues), and sometimes metastasis (spread to other locations in the body). Cancer may affect people at all ages, even fetuses, but risk for the more common varieties tends to increase with age. Cancer causes about 13% of all deaths in world.

Types of Cancer

Cervical Cancer: Prevention is the best cure!

‘Cancer of the cervix’ or ‘Cancer of the mouth of the uterus’ is the second most common cancer in the world and the commonest cancer in India in females. Every year about 1, 32,000 new cases of cervical are detected out of which 74,000 women die due to this cancer in our country. It is indeed ironical that the mortality rate due to this cancer is so high in spite of it being 100% preventable by simple screening method and timely treatment.

Factors causing cervical cancer:
Early and multiple sexual relations, bearing many children, poor genital hygiene, consumption of tobacco are causes which have since long been associated with cervical cancer. Now it has been proven that ‘Human Papilloma Virus (HPV)’ infection is the chief cause of this cancer. There are about forty genotypes of this virus which can cause cervical cancer but 70 % of the cancers are caused by genotypes 16 and 18. Infections by HPV can be transmitted by sexual contact or even by skin to skin contact.

Prevention from cervical cancer: HPV Vaccine -
HPV vaccine which is now freely available helps prevent cervical cancer by inactivating the main disease causing genotypes.

HPV vaccine is a collection of virus like particles made of specialized structural protein. Because there are no live virus particles, it is not infective. Western countries have been using it since many years now and it has been found completely safe in long term studies and research.

Females between 10 and 42 years can be vaccinated by this vaccine and no serious short term or long term effects have been seen. It should not be given during pregnancy. This vaccine is only for prevention from infection and it does not protect already infected females. Therefore, in spite of vaccination, screening for cervical cancer should proceed as per the prevailing protocol.

Diagnosis of precancerous stages:
Cellular changes of precancerous stages of Cancer Cervix can occur in females in spite of vaccination due to other etiological factors including genetic reasons, preexisting infection etc. These changes take many years to convert into invasive cancer depending upon their severity. During these years precancerous lesions can be diagnosed by simple tests like ‘Pap smear’, ‘Liquid based cytology’, colposcopy etc. Once diagnosed, these precancerous stages are 100% curable.

Hence, it is imperative that after the age of 21 years, all women get a ‘Pap smear’ or ‘Liquid based cytology’ done. If these tests are normal, they can be repeated at three to five years’ interval.

Treatment of Cervical Cancer
If a lady is diagnosed to have invasive cervical cancer during screening or gynecological check up, she must consult a Gynecological Oncologist. A Gynecological Oncologist after confirming and staging the disease will decide on the mode of treatment. Most cases of cervical cancers in early stages can be successfully treated by surgery specially designed for this malignancy called ‘Wertheim’s Hysterectomy’ or a combination of radiotherapy and chemotherapy. For younger women suffering from this cancer, fertility sparing surgery and ovarian conservation have also evolved.

Yearly gynecological check up even in asymptomatic females is a must in order to assess their reproductive health. Timely management of many minor problems can help to prevent larger ailments in the future. Besides, this will definitely help in improving the health status of females in the society!   

Dr. Ranu Patni
Gynecologic Oncologist

Endometrial Cancer: Early detection is the key!

Endometrial cancer or ‘Cancer of the body of the Uterus’ is the fifth leading cancer in women worldwide. In developed countries it is the most common gynecological cancer. In developing countries, it is surpassed by cervical cancer. Since Endometrial cancer is a disease of elderly women and women of high socioeconomic status, the incidence is seen to increase with aging of the population and changes in life style. Increasing accessibility to medical care and better diagnostic facilities could also be one of the contributory factors for this increasing incidence.

Risk Factors
Endometrial carcinoma occurs usually in the 6th and 7th decade of life. 75% cases occur in women over 50 years of age. Apart from increasing age and higher socioeconomic status, obesity, early menarche, late menopause, unopposed estrogen therapy, high calorie diet, diabetes mellitus, hypertension, a positive family history and the use of anti estrogens like Tamoxifene for a long time can increase the risk of endometrial cancer.

Prevention and Early Diagnosis
This cancer is largely preventable if diagnosed in the precancerous stage. Also, it carries excellent prognosis if detected in early stage. Roughly, the five year survival rate in stageI is 96% as compared to only 18% in stage IV. Unlike cancer of the cervix, there is no accepted screening test for this cancer. Therefore, it is very important to monitor the endometrial status by yearly gynecological examination especially in women who are at high risk. Any menstrual disturbances or abnormal vaginal discharge problems that occur especially in the elderly and postmenopausal women or that persist in younger women should be evaluated. A timely gynecological examination along with a transvaginal ultrasound and a pap smear gives a fairly good idea of the status of reproductive organs and functions. A thick endometrium should be biopsied either as an office procedure or under anaesthesia. A thin but bleeding endometrium especially in postmenopausal women should also be biopsied. If the histopathological report indicates’ Endometrial hyperplasia with atypia or abnormal cellular/ glandular pattern’ it warrants definitive treatment in the form of surgery. Simple/ complex hyperplasias without atypia can be treated conservatively or with ablative procedures.

Treatment
If frank/ invasive cancer of the endometrium is diagnosed, the lady must consult a Gynecologic Oncologist. The mode of treatment is decided after confirming and staging the disease. In early disease, surgery usually suffices. As the stage progresses, radiotherapy with or without chemotherapy and hormone therapy have to be offered as adjuvant treatments. Life style modifications, relaxation exercises, control of co-morbid conditions and proper follow-up play a significant role in general well being of the patient.

Dr. Ranu Patni
Gynecologic Oncologist          
 
Ovarian Cancer
Main functions of the ovaries are to-           

  • Release eggs every month and thus aid in conception.
  • Produce female reproductive hormones especially estrogen, progesterone and a little bit of testosterone.

Ovaries consist of sex cells which can be differentiated into various types of cells so when an ovarian tumor forms it can sometimes consist of a variety of tissues.

Risk factors

Some of the important risk factors are-

Age - Risk increases with age. Although ovarian tumors are not very common in young age, any ovarian tumor in prepubertal age group or adolescence carries a high probability of malignancy.

Heredity - The life time risk of suffering from ovarian cancer goes on increasing with the number of first degree relatives suffering from the disease in the family. Therefore, a family history of ovarian cancer should not be ignored.

Infertility - Prolonged treatment of infertility can increase the risk by damaging the ovarian capsule.

Personal/ family history of breast cancer - If a lady has suffered from breast cancer in the past, it raises her risk for ovarian cancer.

Symptoms
An ovarian cancer can present with the following:-

  • No symptoms or very vague symptoms in the initial stages like heaviness/ bloating sensation in the abdomen, persistent dyspepsia etc.
  • Pressure symptoms - with enlargement, the tumor presses on the surrounding organs especially urinary bladder and bowel. This gives rise to disturbed bladder and bowel functions like difficulty in passing urine/motion, recurrent urinary tract infections etc.
  • Abdominal enlargement / lump - Abdominal enlargement can be seen when tumor grows very large (12-15 cm) or when fluid fills the abdominal cavity (ascites). Sometimes, a solid tumor can present as a lump.
  • Surgical emergency - Rarely, this situation is encountered in an ovarian cancer. When it occurs, it can be because of twisting / bursting of the tumor inside the abdomen.

 

Abnormal uterine bleeding is not a common symptom of ovarian cancer.

Diagnosis
Early diagnosis and treatment is very important for good curative results but it is also a big challenge because of the vague and late appearing symptoms of the disease.  

A transabdominal and transvaginal ultrasound (with color doppler) helps to document the presence of the tumor and to get an idea about its nature. CT scan / MRI can help in knowing the extent of spread of disease. Certain blood tests called tumor markers can help in diagnosing and following the disease. Whenever fluid is present inside the abdominal cavity or around the lungs it should be collected and tested in the laboratory for presence of cancer cells.

Treatment
After preliminary diagnosis and evaluation, a treatment strategy is planned according to the stage of the disease.

In early stages, surgery is the primary treatment. Apart from removal of the tumor, surgery includes proper staging procedures best done by an expert in the field of gynaec Oncology. Depending upon the final biopsy report, decision about post operative chemotherapy is taken. In advanced disease either extensive surgery followed by chemotherapy is the mode of treatment or chemotherapy can be given in parts before and after the surgery.

Outcome
The outcome of the disease is measured in terms of five year survival. As the disease advances, outcome worsens. Cure rate is almost 95% in stage I and it falls to less than 20% in stage IV. Therefore, early diagnosis and treatment are very important. For this, awareness about the disease and obtaining timely expert opinion and treatment are necessary.

As of now, no screening strategy has been defined for early detection of ovarian cancer. However, yearly gynaecological examination for all adult females even in the absence of symptoms can prove very useful.

Even after successful treatment, the patient should be, closely followed. It is very essential to screen for other malignancies during follow-up visits and to maintain a good quality of life as far as possible.

Dr. Ranu Patni
Gynecologic Oncologist