Healthy cells in our bodies divide and replace themselves in a controlled fashion throughout our lives. Cancer starts when a cell is altered & there is uncontrolled, purposeless multiplication. A tumor is a mass composed of such abnormal cells.
Benign tumors do not spread to other parts of the body. Malignant or cancerous, tumors crowd out healthy cells, interfere with body functions, and draw nutrients from body tissues.
The National Cancer Institute estimates that there has been a significant rise in the incidence of cancer.
Common Cancers in Women
Cervical cancer is cancer that begins in the cervix, which connects the uterus to the vagina. It is the part of the uterus that dilates and opens fully to allow a baby to pass into the birth canal.
In a precancerous stage, usually, there are no symptoms. That is why it is important to have a Pap test. Symptoms develop only when the cells turn into cancer and invade the deeper parts of the cervix or other pelvic organs.
Globally, cervical cancer is the second most common cause of cancer death in women, with an estimated 510,000 newly diagnosed cervical cancer cases every year and 288,000 deaths. In developing countries, cervical cancer is often the most common cancer in women.
Risk factors associated with cervical cancer-
- Human papillomavirus (HPV)
- Low socioeconomic status
- Marriage before 18 years of age
- Young age at the first intercourse
- Multiple sexual partners
- Spouse with multiple sexual partners
- Multiple childbirths
Symptoms of cervical cancer-
- Vaginal discharge
- Abnormal vaginal bleeding
- Offensive odor from the vagina
- Pelvic examination including a rectovaginal exam
- HPV test
- Colposcopy – observing the cervix through a magnifying scope
- A biopsy may be required depending on the results of the colposcopy
- Staging helps to determine the exact extent of cancer and what treatment plan is best.
- Following surgery, cancer will be categorized into Stage I, II, III, or IV.
- Cancer will also be assigned a grade which refers to how abnormal the cells appear under a microscope.
American Cancer Society has provided the following guidelines for screening & early diagnosis of cervical cancer-
- Pap smear cervical cancer screening should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age.
- Screening should be done every year with conventional Pap tests or every 2 years using liquid-based Pap tests.
- At or after age 30, women who have had 3 normal test results in a row may get screened every 2 to 3 years.
- Women 70 years of age or older who have had 3 or more normal Pap tests and no abnormal Pap tests in the last 10 years, and women who have had a total hysterectomy, may choose to stop cervical cancer screening.
Breast cancer is the most common cancer among women. On average, 1 in 8 women develop breast cancer in their lifetimes. About two-thirds of women with breast cancer are 55 years or older. The human breast is made up of adipose along with a complex system of glands and ducts which help in milk production and lactation. Most breast cancers are a result of mutations in these ductal or glandular cells which leads to an abnormal multiplication of cells forming a tumor. Small tumors, cannot be felt but can often still be detected on mammograms or other radiology tests.
Risk factors associated with breast cancer-
- Physical inactivity
- Overweight & obesity after menopause
- Alcohol intake
- Reproductive history.
o First child after age 30.
o No breastfeeding
o Pre-term pregnancy.
- Taking hormones
o Hormone replacement therapy that includes both estrogen and progesterone during menopause for more than 5 years.
o Birth control methods include birth control pills, implants, IUDs, skin patches, or vaginal rings that contain hormones.
Symptoms of breast cancer-
- Swelling of the breast
- Lump in the armpitor collarbone
- Bloodyor clear nipple discharge
- Breast skin that looks like an orange peel
- Breast or nipple pain
- Red, itchy, or thick nipple or breast skin
If a lump is present on self-examination or if something shows up on a mammogram following tests can be advised by the physician-
- Ultrasound- It uses sound waves to take a picture of the breast.
- Mammogram-This detailed X-ray gives a better view of lumps and other problems.
- Magnetic resonance imaging (MRI)-A magnet linked to a computer is used to create detailed images of the insides of the breasts.
- Biopsy-A tissue or fluid is removed from the breast & is seen under a microscope to check for cancer cells & their type.
Breast Cancer Prevention-
- Control weight-Extra pounds and weight gain as an adult raises odds for breast cancer after menopause.
- Start exercising-Exercise lowers the risk of breast cancer. Aim for 150 minutes of moderate or 75 minutes of heavy activity each week (or a mix of the two)
- Limit or skip alcohol- Women should have no more than 1 alcoholic drink a day. That’s 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (hard liquor).
- Breastfeed-Longer breastfeeding is better to lower the risk of breast cancer.
- Limit hormone therapy after menopause-Ask a doctor for non-hormonal options to treat symptoms of menopause.
American Cancer Society has provided the following guidelines for screening & early diagnosis of ca breast:
|Cancer Site||Population||Test or Procedure||Frequency|
|Breast||Women, age 20+ years||Breast self-examination||Monthly, starting at age 20 years.|
|Clinical breast examination||Every 3 years, ages 20-39 years. Annual, starting at age 40 years.|
|Mammography||Annual, starting at age 40 years.|
- Nearly 100% of women whose cancer is only in their breast live at least 5 years after diagnosis.
- In women whose cancer has spread to nearby tissue, 91% live at least 5 more years, and 84% live at least 10 more years.
- If a woman’s breast cancer has spread to nearby lymph nodes, the 5-year survival rate is 86%.
- About 27% of women whose cancer has spread farther in their body live at least 5 more years.
Endometrial cancer is cancer of the lining of the uterus (called the endometrium).
Risk factors associated with endometrial cancer-
- Things that affect hormone levels, like taking estrogen after menopause, birth control pills, certain ovarian tumors, and polycystic ovarian syndrome (PCOS)
- Use of an intrauterine device
- Age (increases with age)
- Physical inactivity
- Type 2 diabetes
- Family history (having close relatives with endometrial or colorectal cancer)
- History of breast or ovarian cancer
- Treatment with radiation therapy to the pelvis to treat another cancer
Grading endometrial cancer-
The grade of endometrial cancer is based on how much the cancer cells resemble the glands found in normal, healthy endometrium.
In lower-grade cancers (grades 1 and 2), more of the cancer cells form glands. In higher-grade cancers (grade 3), more of the cancer cells are disorganized and do not form glands.
- Grade 1 tumors have 95% or more of the cancer tissue forming glands.
- Grade 2 tumors have between 50% and 94% of the cancer tissue forming glands.
- Grade 3 tumors have less than half of the cancer tissue forming glands. Grade 3 cancers tend to be aggressive and have a worse outlook than lower-grade cancers.
Staging of endometrial cancer-
The cancer is classified into four stages based on how much it grows & spreads
- Stage 1-Cancer is only present in the uterus.
- Stage 2-Cancer present in the uterus and cervix.
- Stage 3-Cancer spread is outside the uterus, but not as far as the rectum or bladder. It might be limited to the fallopian tubes, ovaries, vagina, and/or nearby lymph nodes.
- Stage 4-Cancer spread is beyond the pelvic area extending to the bladder, rectum, and/or distant tissues and organs.
Symptoms of endometrial cancer-
- Changes in the duration or heaviness of menstrual periods
- Spotting between menstrual periods
- Vaginal bleeding after menopause
- Watery or blood-tinged vaginal discharge
- Pain in the lower abdomen or pelvis
- Painful sex
Diagnosis of endometrial cancer-
- Transvaginal ultrasound exam-Imaging test that uses sound waves to create pictures of the inside of the body. An ultrasound probe is inserted into the vagina which transmits images onto a monitor.
- If any abnormalities are detected during the ultrasound exam, one or more of the following tests may be advised.
- Endometrial biopsy-A small piece of tissue from the endometrium is removed through the tube using a thin flexible tube inserted through the cervix into the uterus.
- Hysteroscopy- A thin flexible tube with a fiber-optic camera is inserted through the cervix into the uterus which is used to visually examine the endometrium and collect biopsy samples.
- Dilation and curettage (D&C)- If the results of a biopsy are unclear to the doctor another sample of endometrial tissue can be collected using D&C which includes dilatation of the cervix and scraping special tool to scrap the endometrial tissue.
Ovarian cancer is a cancer of the ovaries, which are almond-shaped female reproductive glands that produce eggs and hormones estrogen and progesterone. Ovarian cancer may spread to organs and tissues in the abdomen, pelvis, and lymph nodes, or distant sites throughout the body, such as the lungs.
Risk factors associated with ovarian cancer-
(Same as cervical cancer)
Symptoms of ovarian cancer-
- Pelvic or abdominal pain
- Early satiety or difficulty in eating
- Frequent urination
Other ovarian cancer symptoms include-
- Back pain
- Extreme tiredness
- Weight loss
- Pain during sex
- Acid reflux
- Constipation or upset stomach
- Unusual belly swelling
- Menstrual changes
Staging of ovarian cancer-
- Stage I (stage 1)-The cancer is confined to the ovaries and hasn’t spread to the abdomen, pelvis, or lymph nodes, nor too distant sites. It’s considered early-stage cancer with the highest survival rate.
- Stage II (stage 2)-Cancer has spread from one or both ovaries to other areas of the pelvis but hasn’t spread to nearby lymph nodes or distant sites.
- Stage III (stage 3)-Cancer has spread to nearby lymph nodes and/or other parts of the abdomen, but it hasn’t spread to distant sites.
- Stage IV (stage 4)-Cancer has spread beyond the abdomen. This is considered metastatic cancer, which means cancer has been found in areas outside of the primary cancer area.
Diagnosis of ovarian cancer-
- Pelvic examination-A visual and a physical assessment of internal sexual organs by a primary-care doctor, who may be an obstetrician-gynecologist.
- Transvaginal ultrasound-This test uses high-energy sound waves to detect abnormalities including an ovarian tumor. It may help visualize the size of the ovaries along with any irregularities in the vagina, uterus, bladder, and fallopian tubes.
- Ovarian biopsy-Once an ultrasound spots a mass, it can be determined whether that mass is cancerous or benign with biopsy. When ovarian cancer is suspected, the entire tumor may be removed and tested.
- Computed tomography (CT) scan-After conducting a physical exam and, in some cases, an ultrasound, doctors may use a CT scan to locate a tumor before surgery. A CT scan may also help determine tumor size, as well as reveal whether other organs are affected or lymph nodes are enlarged.
- Magnetic resonance imaging (MRI)-An MRI is often used in combination with other tests as a part of the diagnostic evaluation process. An MRI has greater soft tissue contrast than a CT scan, making it useful in detecting tumors or recurrences in other areas of the body.
- Positron emission tomography-computed tomography (PET/CT) scan- This technology is used to help diagnose ovarian, fallopian tube, or peritoneal cancer. The scan measures a tumor’s ability to use glucose, which is a type of sugar. Faster-growing cells use more sugar and show up brighter on a PET/CT scan.
Blood tests- Biomarkers like CA125 may signal the presence of ovarian cancer cells. However other conditions can also alter the levels. So, test results are not definitive.
Nutrition profile- Patients are evaluated for deficiency of nutrients, such as vitamin D and iron which helps identify which nutrients the patients need to replace to support their quality of life and help reduce the risk of complications from surgery.
Genetic testing- This helps determine whether a patient has inherited genes linked to ovarian cancer i.e. when the mother or grandmother has had a history of cancer. These variants include the well-known BRCA1 and BRCA2 mutations linked to breast cancer, as well as ones called ATM, BRIP1, and MSH2.
Importance of Screening Tests
– These tests are designed to find cancers at an early stage when they are more treatable.
– Some cancer screening tests have been found to lower the death rate from certain cancers.
– Colonoscopy for colon cancer, mammography for breast cancer, and PAP smear for cervical cancer are a few common screening tests used abroad.
– These tests are not popular in India, but one should not hesitate to get screened in case of any warning signs.
General Lines of Treatment for Cancer
Surgery is a common treatment for many types of cancer. During the operation, the surgeon takes out the mass of cancerous cells (tumor) and some of the nearby tissue.
Chemotherapy refers to drugs used to kill cancer cells. The drugs may be given orally or into a blood vessel (IV). Different types of drugs may be given together at the same time or one after the other.
Radiation therapy uses x-rays, particles, or radioactive seeds to kill cancer cells. Radiation therapy damages cancer cells more than normal cells. This prevents the cancer cells from growing and dividing causing their death.
Diet considerations in cancer patients-
- A high protein diet helps in repairing the damage caused by chemotherapy.
- Eating raw or undercooked meat, fish, poultry, or foods & drinking unpasteurized beverages should be avoided.
- Treatments can affect the taste buds & thus there can be decreased taste sensation. Spices can help one enjoy food.
- Drinking plenty of liquids all day to maintain hydration.
Workout considerations in cancer patients:
- Research suggests that exercise is not only safe but helpful during cancer treatment.
- It’s important to avoid movements that cause pain or other issues.
- Ensure to start & progress slow.
- 30 minutes of moderate activity (a movement that includes slightly quicker breath and a light sweat) for 5 or more days each week is recommended.
- Exercises should be customized according to the patient’s condition with prior consent from the treating physician.
Author: Dr Poonam Vichare (INFS Faculty)
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