Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

  Cancer is considered by people as one of the common dreaded diseases of mankind characterized by uncontrolled cell growth or proliferation. Cancer can affect children, men and women. Women are predisposed to certain cancers of reproductive organs as well as other cancers.

The major types of cancers that affect the reproductive system of women are: cervical, ovarian, uterine, vaginal, vulvar and fallopian tube cancers.

Breast cancer and cervical cancer conjointly are the leading causes of death from cancer in women, with over 2.8 million new cases and over one million deaths globally in 2020 [4].

   Among all the cancers affecting reproductive organs of women only cervical cancer has screening tests that can detect this cancer early, increasing the chances of cure. In other types of cancers proper screening tests are lacking and it is very difficult to diagnose the occurrence of cancer very early. Therefore it is crucial to recognize warning signs of cancers in women [gynaecological cancers].

     In August 2020, the World Health Assembly passed a resolution calling for elimination of cervical cancer and adopting a strategy to execute it. With early detection, treatment is most effective preventing metastasis or spread to other parts of the body. Therefore it is very important to diagnose cancers very early in women with great vigilance, recognizing the warning signs of cancer.

    The risk is very high in women with family history of cancers.  A family history of ovarian cancer can enhance the risk for occurrence of ovarian cancers in women.  Breast cancer is one of the most common cancers in women population of western countries with enhanced risk of positive family history. Women with family history breast cancer are recommended to do the screening test after 40 years. The common screening test is mammogram. MRI may be suggested in suspicious cases with positive family history.

 Human papillomavirus (HPV) is the leading cause of cervical, vaginal, and vulvar cancers.  Some of the other common cancers that affect women are breast, colorectal, endometrial, lung, cervical, skin, and ovarian cancers.

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Cervical cancer

Cervix is the lower end of the uterus connected with vagina. Cervical cancer is occurs when abnormal cells in the lining of the cervix proliferate uncontrollably.

It can occur with no clear cut symptoms. However, mostly unusual uterine bleeding and pain during sexual intercourse are the main symptoms of cervical cancer.

Screening test:

 There is screening test called Pap test for cervical cancer before the cellular changes advances into cancer.  It is recommended for every woman above age 45-65. Pap’s test- identifies the presence of human papilloma virus and cellular changes suggestive of cancer.

To perform the screening, your provider will collect a small sample of cervical cells:

The Pap smear test search for precancerous  changes on the cells of cervix that can transform into cancer if left untreated.

The HPV test looks for the virus that causes abnormal cell changes to the cervix.

 An abnormal pap smear test may demand a follow-up screening .

Contracting the infection of human papillomavirus or HPV is the cause for cervical cancer in 90% of the cases.

Risk factors

Smoking

HIV or AIDS infection

Using birth control pills for more than 5 years

Giving birth to 3 or more children

Having multiple sex partners

Cervical cancer does not show signs or symptoms in the initial stages. However, as the disease advances   symptoms of abnormal vaginal bleeding or discharge after sexual intercourse appears.

Pap test and HPV screening can detect cervical cancer early. Pap test is advised  every 3 years [in the sexually active years] or combined Pap/HPV test every 5 years until age 65.

 HPV vaccine is available for women up to the age of 45 to prevent cervical cancer.

Treatment

Surgery  & chemotherapy.

Breast cancer

Breast cancer is a disease in which cells in the breast start growing or proliferating uncontrollably . There are different types of breast cancers. The types of breast cancers are classified depends on the type of cells in the breast which turn into cancer.

   After skin cancer, breast cancer is the second most common cancer diagnosed in women in the United States. It occurs in the breast cells and can spread to the lymph nodes under the arms.

Risk factors :

 Obesity or overweight

A sedentary lifestyle

Not becoming pregnant

Not breastfeeding

Drinking alcohol

Use of birth control, particularly oral contraceptives

Hormone therapy after menopause

Signs &symptoms :

Breast lump

Lump in underarm

Nipple discharge –

Breast or nipple pain

Nipple retraction (inward into the breast)

Nipple changes

Dimpling in your breast (like an orange peel)

Swollen breast

Red, itchy, scaly or thick skin on your breast

Screening

Women with a strong family history of breast cancer may do genetic testing to learn if they've inherited a mutation of the BRCA1 or BRCA2 genes. Normally, BRCA1 and BRCA2 are tumor suppressor genes that play a primary role in stopping abnormal cell growth in breasts, ovaries and other cells. If one of these genes is broken, it can increase the risk of developing cancer. When a parent carries a BRCA gene mutation, their male and female children have a 50% chance of inheriting it.

Treatment :

Surgery, chemotherapy

Prevention :

Consume a healthy nutritious diet, be physically active, breastfeed if you have children and see your healthcare provider annually for routine screenings.

The Global Breast Cancer Initiative, GBCI established by WHO in 2021.Through GBCI, WHO provides guidance to governments across the world on ways to strengthen systems for detecting, diagnosing and treating breast cancer, to further their capacities to manage other types of cancer. GBCI employs 3 key strategies to achieve these objectives: health promotion and early detection; timely diagnosis; and comprehensive breast cancer management.

Prophylactic  mastectomy- surgical removal of healthy brests in women who are at high risk of cancer ,that is , diagnosed as BRCA gene mutated women. They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

Ovarian cancers

Ovarian cancers arise by the uncontrolled proliferation of cells of ovaries. Cancerous epithelial tumors are the most common type of ovarian cancer. The following are subtypes of ovarian carcinoma:

·       Serous carcinoma

·       Endometrioid carcinoma

·       Clear cell carcinoma

·       Mucinous carcinomas

Signs &symptoms include:

Symptoms are often  absent or vague and it may point to diseases of other systems of the body such as gut and therefore diagnosis of ovarian cancer is often delayed. Any of the following symptoms are possible to occur, although most ovarian cancers do not show any symptoms in the initial stages.

·       Pelvic pain

·       Lower back or abdominal pain

·       Menstrual changes

·       Weight loss

·       Bloating

·       Feeling full quickly

·       Difficulty eating

·       Nausea

·       Pelvic pressure

·       Vaginal bleeding

·       Abnormal vaginal discharge

·       A change in bowel habits

·       Frequent or urgent urination

·       Frequent or urgent bowel movements

·       Constipation

Most symptoms listed above occur as the tumor compresses on the adjust structures or organs within the pelvis 

Screening

 Cancer symptoms are often vague and therefore early detection is difficult. It is often discovered as an incidental finding on ultrasonogram done for other purposes such as urinary problems, abdominal discomfort ,back pain etc.

Those who are already diagnosed as BRCA gene positive should see a gynecologic oncologist to perform additional screenings for ovarian cancer.

 Women suspected with ovarian cancer symptoms can receive the following tests:

CA-125 blood marker:

 It evaluates your blood for a protein that is elevated in ovarian cancer. However it is not confirmatory. This marker can be elevated in other conditions also eg: endometriosis or pregnancy.

Transvaginal ultrasound:

An ultrasound probe that is inserted into your vagina to examine your pelvic organs can visualize the tumor.

Treatment :

Surgery and chemotherapy

Colorectal cancer

Colorectal cancer affects the colon or the rectum. Most colorectal cancers originate from a polyp in the intestine as a small benign growth on the lining of the colon or rectum.

The risk factors associated with colorectal cancers include :

·       overweight or obesity

·        physical inactivity

·       a diet high in red and processed meats

·       A low-fiber, high-fat diet

·       Diabetes

·        smoking

·       heavy alcohol consumption

·       old age

·        a positive family history of colorectal cancer or polyps

·        family history of Lynch syndrome or familial adenomatous polyposis

·         history of  having polyps or colorectal cancer

·       Chronic inflammatory intestinal disease (ulcerative colitis or Crohn's disease)

    Screening can help to find colorectal cancer at the earliest before metastasis or spread happens to other sites of the body. Certain screening tests such as endoscopy to find out polyps can also help in preventing colorectal cancer by removing polyps before they turn into cancer.

It is recommended that women should start regular screening at age 45. Endoscopy may help to find out polyps as well as cancers of gastrointestinal tract.

Cancer can occur in any part of the colon: caecum , ascending colon, transverse colon, descending colon, sigmoid colon .

Signs &symptoms

Dark, bloody, thin or tarry stools from bleeding or obstruction in your GI tract.

Constipation or diarrhea or any other change in bowel habits

Intense abdominal pain or cramps

Weakness and fatigue

Unexplained weight loss

Increased bowel movements due to a tumor

Abnormal growths, called polyps, can form in the colon or rectum. These abnormal growths, left untreated, can turn into cancer and grow through the walls of the colon and into the rectum. If they spread to other areas in the body, it is known as metastatic cancer.

Screening tests in several different ways:

Stool test – checks your stool for signs of polyps or cancer annually

Sigmoidoscopy  &Colonoscopy –endoscopic examination of colon.

Treatment

Surgery, chemotherapy.

 Written by dr sanjana vb[copyright]

References for further reading

1.    https://www.cancerresearchuk.org/about-cancer/cervical-cancer

2.    https://www.cdc.gov/cancer/gynecologic/basic_info/index.htm

3.    https://www.kucancercenter.org/news-room/blog/2020/08/most-common-cancers-women-how-to-detect-them-early

4.    https://www.uicc.org/what-we-do/areas-focus/women-and-cancer

5.    https://www.who.int/initiatives/cervical-cancer-elimination-initiative/strategy

6.    https://www.who.int/initiatives/global-breast-cancer-initiative