Gynaecological cancer (Women’s Cancer)
The disease more often than not invades womanʼs sexual organs. By Dr B. L. Nagpal
Gynaecological cancer or cancer of the female genital tract including breast, is fairly common in the world although its distribution in various organs varies from country to country and even region to region within the same country. The frequency of occurence of gynaecological cancer is high in Asian countries including India.
The distribution of cancer in various parts of female genital tract has been shown as follows:
cervix, 58.7 per cent; body of uterus, 21.5 per cent; ovaries, 12.8 per cent; vulva, 4.9 per cent; vagina, 1.9 per cent and fallopian tube, 0.2 per cent. In India, however, cancer of the every rank next to cervix uteri carries a high mortality rate. When breast cancer is taken into consideration along with it, it displaces the ovarian cancer and occupies the second position. Not only that, it is trying to overtake the cervical cancer. Although for certain types of cancer, the causative agent(s) and promoting (risk) factors are now well established the fundamental cause of cancer still remains unknown. The nature and results of its treatment are unsatisfactory.
The causative agent for cervical cancer is human papilloma virus (HPV) and the promoting factors are: early marriage/early age of sexual intercourse, promiscuity, poor genital hygiene, both in male and female; prostitution, low socio-economic conditions, multiple child births, lowered immunity and cervical erosion/irritation, etc.
The HPV is introduced for the first time into vagina by the infected male sex-partner during sexual intercourse. Later on, it becomes the permanent resident there. At an appropriate time, when the stage is set, it makes its entry into the epithelial cell(s) of cervix.
The viral DNA (deoxyribe nucleic acid) becomes an integral part of cellular DNA leading to cell(s) mutation and transformation of normal cell(s) to pre-cancerous cell(s). The pre-cancerous stage may last for five-10 years.
Round about the age of menopause, under some unknown stimulus hormonal, lowered immunity, the precancer changes to frank cancer.
CAUSES OF CANCER
Very little is known about the causation of cancer of the breast, body of uterus, vulva, vagina and fallopian tube. Whatever is known, particularly about breast cancer is based on statistical studies. Conclusions based on purely statistical studies, devoid of experimental laboratory evidence, are often unreliable and may be misleading. It has been rightly said that, “statistical data are like a miniskirt, it gives lot of information, yet hides the most vital facts.
R. A. Willis – the man who gave the definition of a ʻtumourʼ which was acceptable to the entire medical fraternity and widely used in medical textbooks all over the world – has commented on the same issue in a manner somewhat like this, “In Great Britain, the incidence of beast cancer doubled in the past 25 years, and it has been observed that banana consumption in Great Britain increased 10 times during the same period, hence banana is the cause of breast cancer.”
TYPES OF GYNAECOLOGICAL CANCER
Cancer of the breast manifests itself usually in the form of a lump which is discovered by the woman herself during bathing or changing of garments.
Other manifestations may be. bloody discharge from the nipple, nipple retraction, thickening or erosion of areola, generalised hardness or shrinkage of the breast.
Most patients of ovarian cancer are asymptomatic. When symptoms appear, they may be in the form of abdominal distension, lower abdominal pain, menstrual disturbances and weight-loss.
Cancer of the vulva presents as a cauliflower–like growth or an ulcer or an indurated plaque on the labia majora or labia minora or clitoris in elderly women in the age-group of 60-80 years. Itching, pain and bleeding are common symptoms. Foul smelling pus may bathe the vulva and adjacent skin.
It is generally agreed that cancer is curable if detected early. An early cancer is more amenable to cure than one which has been present for some time. More than 60 per cent of women cancer patients in India belong to either cancer of the uterus or the breasts. Fortunately, these cancers can be detected at a very early stage, even at a pre-cancerous stage. If treated properly and effectively, a cure can be expected. However, it is to be accepted that, although early diagnosis and treatment must provide a better chance of survival, they do not do so always as might be expected. Some cancers are resistant to treatment. The need of the hour is to create awareness among women and to educate them to identify and pay heed to first suspicious symptom or sign – eg, irregular vaginal bleeding or vaginal discharge or a lump in the breast after the age of 40. The role of various mass media of communication cannot be overemphasised in achieving the desired results in this regard. At the same time, government must provide medical facilities, particularly in rural areas.
SEEK MEDICAL ADVICE
On the slightest suspicion of cancer, women should consult their doctor immediately and get assured that it is not cancer. There is no need to become panicky as the chances for non-cancerous disease are much more and medical consultation is required to exclude malignancy. However, women themselves are slow to react, hence the delay. Women are more worried about their children, husband, family and home than their own health. Some women with genuine symptoms fail to report to a doctor because they do not wish to have their fears confirmed whereas others would prefer to remain in doubt and leave matters to fate.
A regular medical check-up has been shown to be a better method of discovering cancer before it has become invasive or, if already invasive, it is still asymptomatic. This involves the routine screening of apparently normal women who are at risk. The medical examination should be carried out by an expert who should concentrate not only on cervical cancer but also on all the pelvic organs and other systemic diseases such as hypertension, diabetes and even obesity. Colposcopy and PAP smear tests should be done merely as part of general physical examination and not the exclusive examination. The American Cancer Society, for early detection of cervical cancer, recommends a PAP smear test once in three years after the start of sexual activity. After the age of 30, women with three normal tests, may be screened every two-three years. They may choose to stop screening after the age of 70 if they have had no abnormal results within the last 10 years. All other women should have an annual screening by a PAP smear test.
Similarly for breast cancer, the same society, recommends breast self-examination (BSE) every month after the age of 20 years, clinical examination of breasts by a doctor every three years between 20-40 years and annually thereafter, with mammography every year after the age of 40.
BSE, which costs nothing except the time, is more suited to women of poor countries like India where it should be popularised and practised by women throughout their lives. It is hoped that the editor will take a note of this and will reprint the same article for the benefit of newer generations of women.
Mammogram is a specialised Xray of the breast. Mammography can detect a very small lump in the breast even before it becomes palpable. However, its benefits over clinical examination and BSE remain controversial.
Studies have shown that there is no difference in long-term survival after treatment between those patients who had undergone mammography and who did not go for it. Further, mammography carries a risk of radiation hazards and is a costly affair.