Catch it early
DR. RISHMA DHILLON PAI
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Regular screening helps detect and treat malignancies in time.
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Women’s health has several unique issues: problems of menstruation, child bearing, hormonal and other gynaecological diseases. The most worrisome is cancer. Certain cancers are unique to women like cervical cancer, ovarian and uterine cancer. B
reast cancer, though it occurs in men also, is mainly seen in women.
Ovarian cancer usually develops in women over 50 years though some kinds develop in younger women. The risk factors are family history, or women who have had breast/uterus/colon cancer in the past. Women who have never been pregnant, who have taken oestrogen for more than 10 years are also at a higher risk. Nowadays genetic testing can be done in high risk families and if the patient tests positive for the BRCA I & II gene (associated with breast cancer), 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.
The use of oral contraceptive pills, however, reduces the risk of ovarian cancer while the removal of ovaries during hysterectomy prevents later development. Ovarian cancer is very dangerous as it is not easily diagnosed till an advanced stage. The only symptoms may be heaviness and bloating in the stomach, gas, nausea, or diarrhoea. Sometimes irregular vaginal bleeding may be seen.
The diagnosis is made by a pelvic examination, sonography, blood test such as CA 125 and MRI and treatment usually involves a major surgery — to remove the uterus, tubes, ovaries and the surrounding tissue — followed by chemotherapy.
Cancer of the uterus 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. Women who menstruated early and had late menopause, infertility or a past history of breast or ovarian cancer are at a higher risk.
First sign
Usually, the cancer is preceded by endometrial hyperplasia or thickness of the womb lining, which is non-cancerous. If diagnosis can be made early using sonography, the development can be prevented by use of hormonal medicines or a hysterectomy. However, if not picked up early, hyperplasia may progress to cancer. The symptoms are irregular bleeding, post-menopausal bleeding, pain or lump in lower abdomen or weight loss. The final confirmation is done by an endometrial biopsy or D&C or a hysteroscopy.
The treatment is essentially surgical involving removal of the womb, tubes, ovaries and surrounding tissue. Hormone therapy, radiation and chemotherapy may be required in some cases.
Breast cancer is one of the commonest cancers in women but the cause remains unknown. However about 10 per cent may be due to genetic causes. Women bearing a defective breast cancer associated gene (BRCA I & II) are at an increased risk. Women who start their periods early and have late menopause andlate pregnancy or those who have never had children are also at high risk. Long-term use of HRT may increase the risk.
The importance of regular breast self-examination cannot be over-emphasised. An annual mammography and sonography after the age of 40 will help pick up the problem early and simplify treatment. If there is a suspicious area on mammography, a fine needle aspiration biopsy (FNAC) or open biopsy 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 be necessary. Often radiation or chemotherapy is necessary after surgery. Hormone-dependent breast cancers often need hormone blocking drugs after surgery.
“As I see it, everyday you do one of two things: build health or produce disease in yourself.” Adelle Davis
The writer is a Consultant Gynaecologist based in Mumbai
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