Cancer’s big five

Cancer is one of the most dreaded ailments, and from amongst the very many types of cancer, there are a few that Indian women are predisposed to.
47.2 percent of cancer in women is accounted for amongst the five types. The surprising fact is that these cancers can be prevented by early screening. Early detection and treatment reduces not only the death rate but the quality of life post cancer treatment. Dr Neena Singh, Associate Director, Obstetrics & Gynecology, Fortis La Femme, Delhi sheds some light on this.
She reveals the following are the top five types of cancer in women in India:

1. Breast Cancer
   Breast cancer is the most common cancer in women in India and accounts for 27 percent of all cases of cancer in women. It is more common in urban areas than rural areas.
   High risk factors:

• Family history of breast cancer
• Long period of OCP (Oral contraceptive pills)
  Screening test for breast cancer:
  *Self-examination of the breasts. If any abnormality found like lump, pain or change in shape, consult a doctor who would examine clinically if it is cancer.
  *Mammography is done which can detect small lesions.
  *MRI Breast is done for staging the disease.
  *Treatment at early stages carries good prognosis.

1. Cervical Cancer
   Cervical cancer is the second most common cancer in India in women accounting 22.86 percent of all cancer cases in women. It is more common in rural women than urban women.
   Risk factors:

• Young age at first intercourse (less than 16 years)
• Multiple Sexual partners
• Cigarette smoking
• Human papillomavirus infection (HPV)
• Immunosuppression
  Screening test for cervical cancer:
  Any abnormal symptoms like abnormal vaginal bleeding, vaginal discharge and contact bleeding (bleeding after intercourse) report to a gynecologist who would do a clinical examination and do some test on cervix.
• Visual inspection with acetic acid (VIA)
• Visual inspection with legal Iodine (VILI)
• Magnified VI! Under colposcopy
• Exfoliative cytology (Pap smear)-is gold standard for screening.
• HPV-DNA testing
• Do cervical biopsy for confirmation. Early detection and treatment have very good prognosis.
• Prevention by prophylactic vaccinations in childhood.

1. Uterine cancer
   Uterine cancer is a type of cancer that begins in the uterus in its lining called the endometrium. Hence, it is also named as endometrial carcinoma.
   Risk factors:

• It is an estrogen dependent cancer. Persistent unopposed stimulation of endometrium with estrogen is the single most important factor for development of cancer endometrium.
• Polycystic ovaries
• Granulosa cell tumor of the ovary which secret estrogen
• Hormone replacement therapy-unopposed estrogen therapy
• Early onset of periods & late menopause (after the age of 50)
• Age: 75 percent women who are post-menopausal
• Nulliparity
• Obesity, hypertension & diabetes (corpus cancer syndrome)
• Tamoxifen therapy given in breast cancer
• Endometrial hyperplasia especially atypical
• Following radiation exposure to the pelvis
• Family history of cancer uterus breast, ovary & colon
  Screening test for uterine cancer:
  If any irregularity in menstrual cycle, post-menopausal bleeding, contact bleeding and unhealthy vaginal discharge report to a gynecologist who would do the following:
  *Clinical examination
  *Transvaginal Sonography (TVS) to know endometrial thickness or irregularity.
• MRI pelvis can be done for more details
  *Fractional curettage of uterus for histopathology examination or Hysteroscopy & directed biopsy from suspicious area. Early diagnosis & treatment has very good prognosis.

1. Ovarian Cancer
   Ovarian cancer constitutes 15-20 percent of all genital cancers. 85-90 percent of all cancers are epithelial in origin. Germ cell constitutes 5-7 percent.
   Risk factors:
   Unfortunately, ovarian cancer doesn’t produce any specific symptoms. By the time symptoms appear its already in advanced stages. However, if patients have pain in the abdomen, back ache, indigestion, bloating not responding to basic treatment and lasts for more than two weeks then consult a gynecologist.
   Screening test for uterine cancer:
   No specific screening method is available. Doctor would do a pelvic examination to feel for ovarian mass.

• Transvaginal sonography (TVS) to confirm ovarian mass solid or cystic.
• Blood test like CA125 which is found raised in ovarian cancer.
• CT Scan /MRI to know spread of cancer
  Treatment:
  Early diagnosis and treatment carry good prognosis.

1. Colorectal cancer
   When a cancerous growth originates in the colon and then spreads to the rectum, it leads to colorectal cancer. The risk of colorectal cancer is higher after the age of fifty years.
   Risk factors:
   *Smoking
   *Fat rich diet
   *Crohn’s disease
   *Colitis
   *Family history of colorectal cancer or polyp
   *Non residual diet
   *Chronic constipation
   Screening test for colon cancer:
   *Frank blood in stools
   *Fecal occult blood test is positive
   *Double contrast barium enema (DCBE)
   *CT Scan
   *Colonoscopy
   *Stool DNA test (IANS)