What you read here can save your life
What you read here can save your life
"Health is not valued till sickness comes."
A woman's health has several unique issues problems of menstruation, child-bearing issues, hormonal and other gynaecological diseases. The most worrisome of these is cancer. Certain cancers are unique to women, like cervical, ovarian and uterine cancer. Breast cancer, though it occurs in men also, is mainly seen in women. 
Unfortunately in India, there is no accurate data and information on incidences of cancer in women. A rough estimate is that one-fourth of the world's total number of new cases of cervical cancer, about 1,30,000 new cases are seen in India each year. About 74,000 women die of cancer of the cervix in India each year.
Breast cancer incidence is increasing in India by about three per cent per year. Approximately one lakh new cases are seen each year. About 80 new cases of breast cancer per one lakh population per year are seen in India.
Cancer of the cervix
In India, cancer of the cervix, the mouth or opening of the uterus, is the commonest cancer in women. This is a slow-growing cancer and many years before the cancer develops, there are changes in the cervix called dysplasia.
Cervical cancer may have no symptoms initially, but in later stages there may be vaginal discharge, inter-menstrual bleeding or bleeding after intercourse. Sometimes a woman has been in menopause for a few years, and then starts bleeding again. This is dangerous and should be checked immediately.
As it is a slow-growing cancer, it can be picked up easily by doing a PAP smear, a two-minute painless test done by brushing the opening of the uterus with a cotton swab or brush. Every woman who is sexually active should have one every year, starting a year or two after she starts having sex. If there is any suspicion of abnormal cells on the PAP smear, the lady should undergo a biopsy to confirm the presence of cancer.
Very early cancer can be treated by a cone biopsy a small surgery during which the inner part of the cervix is removed, keeping the uterus (womb) intact. In advanced cases, a major surgery involving removal of uterus is necessary.
It has now been proved that most cervical cancers are caused by an infection with the human papilloma virus (HPV), a sexually transmitted disease. HPV can cause warts in the genital area in some patients, while some strains of the virus cause cancer. As it is caused by an infection, it is a preventable cancer. The important factors for prevention are: not to start sex at a young age, not to have multiple partners, use condoms to prevent HPV transmission, avoid smoking and reduce long term use of oral contraceptives.
Now, there are safe vaccines available in India to prevent HPV infection. These is recommended to all young girls and women.
Ovarian cancer
Ovarian cancer usually develops in women over 50, though certain types of ovarian cancer can develop in younger women. The risk factors for ovarian cancer are a family history of ovarian cancer, or women who have had cancer of the breast, uterus or colon in the past. Women who have never been pregnant or women who have taken the estrogen hormone for more than 10 years are also at higher risk. Nowadays, genetic testing can be done in families at high risk and if the patient is positive for BRCA I & II gene (breast cancer-associated gene), she is at high risk for ovarian and breast cancer. Increased use of fertility drugs, using talcum powder near the vagina and obesity are also risk factors for ovarian cancer.
Use of oral contraceptive pills reduces the risk of ovarian cancer. The removal of ovaries during hysterectomy prevents the later development of ovarian cancer. This is a very dangerous cancer as usually it does not cause any symptoms till it is in an advanced stage. The only symptoms may be a feeling of heaviness and bloating in the stomach, gas, nausea, or diarrhea. Sometimes irregular vaginal bleeding may be seen.
The diagnosis is made by a pelvic examination, sonography, blood test such as CA 125 and MRI. The treatment is usually a major surgery to remove the uterus, tubes, ovaries and the surrounding tissue. This is often followed by chemotherapy.
Cancer of the uterus (womb)
This is another common cancer in women. This occurs more often in obese, diabetic women after age 40.
Women who have suffered from polycystic ovarian syndrome (PCOS) when young and had delayed periods for a long time without treatment are more prone to uterine cancer. Women who start menses at an early stage and have late menopause, women with infertility or a past history of breast or ovarian cancer are at a higher risk.
Usually, the cancer is preceded by endometrial hyperplasia or thickness of the lining of the womb, which is non-cancerous. If the diagnosis can be made early using sonography, the development of cancer can be prevented by use of hormonal (progesterone) medicines or by doing a hysterectomy (removal of the womb). However, if not picked up early, hyperplasia may progress to cancer. Symptoms in a patient of endometrial cancer are irregular bleeding, postmenopausal bleeding, pain or lump in lower abdomen or weight loss. The final confirmation of cancer is done by an endometrial biopsy or D & C (curetting of the womb) or a hysteroscopy (looking inside the womb with a thin telescope).
The treatment is essentially surgical, which involves removal of the womb, tubes, ovaries and surrounding tissue. Hormone therapy, radiation and chemotherapy may be required in some cases.
Breast cancer
Breast cancer is one of the commonest cancers in woman. Its cause is unknown. However 5-10 per cent cases may be due to genetic causes. Women bearing a defective breast cancer associated gene (BRCAu00a0 Iu00a0 & II) are at increased risk of breast and ovarian cancers. So family history of breast cancer is one of the highest risk factors for developing cancer. Women who start their periods early and have late menopause and late pregnancy or those who have never had children are at a higher risk for developing breast cancer. Long-term use of hormone replacement therapy may increase risk of breast cancer.
The importance of regular breast self examination cannot be over emphasized. An annual mammography and sonography after the age of 40, will help pick up breast cancer early and hence simplify its treatment. If there is a suspicious area on mammography, a fine needle aspiration biopsy (FNAC) or open biopsy of the lump will confirm the diagnosis.
The treatment is usually surgical. In early stages, a lumpectomy with sampling of lymph nodes while saving the breast may be sufficient, but in later stages a mastectomy or removal of the breast may necessary. Often radiation or chemotherapy is necessary following surgery. Hormone dependent breast cancers often need hormone-blocking drugs to be given for a long time following surgery.
Besides gynaecological cancers, cancers of lungs and colon cancers are also common in women.
Women owe it to themselves and to their families to do regular cancer screening as some of the cancers are preventable and others can be treated completely if diagnosed early.
"As I see it everyday you do one of two things build health or produce disease in yourself." Adelle Davis
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