Cancers in Women - Malignancy secondary issue

Dr. (Ms) See Hui Ti of Parkway Cancer Centre, Singapore talks in detail of breast cancer and the three types of gynecological cancer - cervical, uterine and ovarian in a recent interview.

Breast cancer which is the second leading cause of death in women today affects around 1.2 million people in the world. Older ladies , mainly who are above the age of 50, patients who have had breast cancer, women with family history of breast cancer, the ones who had late menopause and BRCA 1 and 2 carriers are at a high risk of getting breast cancer.

Dr. (Ms) See Hui Ti

"It is always advisable to pay attention to normal and abnormal swelling and hardening of the breasts, obvious changes and inversion on the nipple, bloody or non bloody nipple discharge, skin changes on the breast and nipple, and also any changes in the size of the breast.

Cervical cancer

The cervix which is located at the lower narrow part of the womb is where the menstrual blood flows out and leaves the body. Out of the several types of cervical cancer, the two most common ones are the squamous (flat) cell type and the adeno (gland) carcinoma type.

Adeno carcinoma and the other rare subtypes are not preventable because the causes for them are still not known. Squamous cell type is preventable.

"Around 90% of cervical cancer is related to the human papilloma virus (HPV) which causes many infections ranging from hand to foot warts (warts that grow on the underside of the foot) , to sexually transmitted vaginal and anal warts. Sexually transmitted HPVs can cause cervical cancer. If the person is sexually active at a very young age and if engages in unprotected sex the risk of getting HPV infection is high.

Signs and symptoms of cervical cancer include post-menopausal bleeding, irregular menses, inter menstrual bleed and unusual and smelly discharge. At later stages patients may experience back pain, pain during urination, sexual intercourse, and bleeding after defecation.

Cancer of the cervix can take many years to develop. Before cervical cancer develops early changes do occur in the cells of the cervix.

Abnormal cells that grow which are called cervical intra-epithelial neoplasia (CIN) are not cancerous, but may lead to cancer in the long run. Anyway some tend to call the development of these cells as pre-cancerous. If left untreated there is a possibility for those cells to develop into cancer.

"But you should note that most women with CIN do not develop cancer." If a woman suffers CIN during pregnancy tracheolectomy can be performed to preserve the uterus. Foetus may be allowed to remain till delivery.

At the early stages chemo-radiation can enhance the cell-kill by radiation, improves the response and survival of the patient.

Sexually active women should undergo a Pap-Smear test every year . If results are normal for two to three consecutive years, it is safe to go every three years.

Uterine cancer

Endometrial cancer and sarcoma of the uterus are the common uterine cancer types. If diagnosed at stage 1 endometrial cancer is 70% curable.

Uterine cancer is mostly age related. Elders are at high risk of getting it. Obesity, early menarche, late menopause, over estrogen stimulation- intrinsic/extrinsic, diabetes (attached with obesity), familial cancers - related to colorectal cancer- Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome-HNPCC).

Signs and symptoms are as same as those of cervical cancer- post-menopausal bleeding, irregular menses, intermenstrual bleed, unusual and smelly discharge from the vagina. At late stages patient may suffer from back pain,., pain upon urination, sexual intercourse, pain, bleeding upon defecation.

Risk factors for ovarian cancer are family history ( if there's one first degree relative, a person is 5% at -risk of getting ovarian cancer. Two 1st degree relatives. 10x more likely. If there' re no relatives who suffered ovarian cancer, a person is 1.5% risk of getting it. Thus those with a family history of ovarian cancer should consider screening.

Reproductive history is another major risk factor. If women who have had early menses, who have never given birth, given birth to her first child after age 30 and women who had experienced menopause after age 50.When asked if there is a way to reduce one's risk of ovarian cancer Dr. See responded in the affirmative. " Women who have had at least one child and breast fed are less likely to develop ovarian cancer."

As she further noted prophylactic oophorectomy ( removal of ovaries) may reduce the risk in women who have a very strong ovarian cancer family history or who carry a known hereditary ovarian cancer gene mutation.

" However this does not prevent the risk of primary peritoneal cancer ( a cancer related to ovarian cancer) and it may have unwanted side effects.

"Hence careful discussion of the pros and cons need to be carried out before considering this option." Dr.See cautioned.

"Because the ovaries lie hidden in the pelvis, ovarian cancer does not cause many symptoms until the disease is advanced except vague symptoms like abdominal discomfort, pressure in the pelvis, pain or swelling of the abdomen."

When asked about the available screening tests she said that screening for early detection of ovarian cancer has not been proven to be effective either alone or in combination. "There are however ongoing clinical trials looking for the best method to screen for ovarian cancer."

Quoting JNCI, Journal of the National Cancer Institute 2008 Dr. See said that excess body fat promotes breast cancer growth and that reducing body fat and increasing physical activity improve the chances of survival.

Results of the Million Woman Study, a longitudinal cohort study of 1.2 million women in the U.K in its conclusion states that being overweight or obese is associated with a higher risk of postmenopausal breast cancer and lower survival.