Let’s discuss two of the most common cancers affecting women. Breast cancer is one of the common cancers to affect women followed by colorectal, lung, cervical, and thyroid cancer. It has been on the rise in modern days. Almost 1 million cases are reported in India per year. It can kill almost one in eight women during their lifetime. Men can also be affected by breast cancer. But, the incidence of occurrence is very slim.
WHAT IS BREAST CANCER?
Breast cancer is the most malignant cancer of the breast. It is a condition in which the cells in the breast grow out of control. The type of breast cancer depends on the kind of cells in the breast that develops into cancer.
CAUSES OF BREAST CANCER:
Some of the major causes of breast cancer include,
- In pre-menopausal women,
- Consumption of alcohol
- Greater birth weight. Weight attained through adulthood.
- Greater height and weight attained as adults
GENERALLY CERTAIN RISK FACTORS INCLUDE
- The chances of getting breast cancer increase with an increase in age.
- Family history of breast or ovarian cancer
- Avoiding breastfeeding and certain hormonal factors
- Mutation of the genes- mainly the BRCA 1 and BRCA 2
- Excess use of birth control pills or hormonal replacement therapy (menopausal hormonal therapy)
- Having the 1st child after the age of 35. Not having children (nulliparity)
- Women with past history of breast cancer
- Lack of exercise or physical activity
- Early menstruation (before the age of 12) and late menopause (after the age of 55)
SIGNS AND SYMPTOMS OF BREAST CANCER:
Some of the symptoms of breast cancer include,
- The feeling of a lump in the breast or under the arms (visible or palpable mass)
- Any rough patches or thickening. Swelling of the breast.
- A hard mass with irregular borders
- Any obvious change in the shape or size of the breast
- Discharges from the breast
- Redness or flakiness over the skin of the breast. Irritation or dimpling of the skin of the breast.
DIAGNOSING BREAST CANCER:
There are many ways of diagnosing breast cancer. The modalities mainly depend upon the stage of presentation and the symptoms reported.
A physical examination is done.
The symptoms are recorded and the family history is obtained.
A NEEDLE BIOPSY:
- A needle biopsy is usually done in cases of obvious or palpable lumps in the breast
- A needle is used to draw fluid and tissue around the lump and the sample is studied for the presence of cancer cells.
- A mammogram is a special form of imaging used to study the breast.
- In this technique, the breasts are compressed horizontally and obliquely by the machine and the imaging is done
Other tests include
- The ultrasound
- The MRI
- Positron Emission Tomography scan (PET scan)
- Self-evaluation of the breast.
MANAGING BREAST CANCER:
Like the other types of cancers managing breast cancer also depends upon the grading and staging of cancer.
Non-surgical modalities of treatment include,
Cancer is treated by chemotherapeutic drugs. They act by destroying cancer cells. In contrast, slow down the rate of spread of cancer. In the case of breast cancers, sometimes the drugs are given before surgery. This is usually done in patients who have larger tumors or the metastasis of the tumor has already set in. After shrinking the size of the tumor removal through other means can be performed without the need to remove a lot of surrounding tissues. In case of widespread metastasis, chemotherapy is an option.
Meanwhile, radiation therapy is not performed alone. In most cases, it is done along with surgery or after surgery. Again as we read before, radiation therapy could be in the form of either external beam radiation therapy or brachytherapy the source of the radiation is implanted inside the body. They either kill the cancer cells or avoid them from developing.
In short, hormones are chemical messengers of the body. They maintain and regulate the various functions of the body. Similarly, one such important hormone is estrogen. Estrogen is important in the growth and regulation of various functions of the uterus, ovaries, breast, etc. Sometimes estrogen can also promote the growth of certain hormone receptor-positive cancer cells.
A particular type of hormone therapy prevents the binding of the hormone estrogen to the cancer cells of the breast and hence prevents further growth of the tumor or the cancerous process.
Targeted therapy is designed to act upon very specific chemical markers that are found on the surface of the cancer cells.
HER-2 is a naturally occurring protein on the surface of the cells. This normally promotes the growth of cells. Some cancer cells have too much of this protein that in turn promotes aggressive growth of these cells.
Targeted therapy for breast cancer is designed in such a way that these drugs only attach to the HER 2 protein and destroy them, thus preventing any further destruction.
Immunotherapy is also known as immuno-oncology and it aims at enhancing the immune system to fight against cancer. Cancer can sometimes hide from the immune cells that attack them.
Both the immune system and the cancer cells have a particular type of protein known as ‘checkpoint proteins’. When they attach the attack from other immune cells is stopped. Drugs that can block the checkpoint protein from attaching to each other can aid the immune cells and enhance them to attack the cancer cells properly. This therapy is under research and more data is needed before implementing the on patients for treatment.
SURGICAL MEANS OF THERAPY:
Surgical means of treating breast cancer includes the following,
In this procedure, the tumor is removed along with some normal tissue surrounding it. The amount of tissue removed depends upon the size of the tumor. Radiation therapy is usually done after a lumpectomy.
TOTAL/ SIMPLE MASTECTOMY:
In this procedure, the complete breast is removed. Depending on the spread of cancer some nearby lymph nodes and underlying muscles could also be removed.
MODIFIED RADICAL MASTECTOMY:
In this procedure, the entire breast affected by cancer along with some lymph nodes and surrounding tissue is removed.
The surgeries are performed based on the level of involvement of cancer.
Thus, a combination of surgical and non-surgical methods can be used to treat cancer.
Yet another cancer that poses a great threat and taunts women is cervical cancer. Cervical cancer is also very common in women.
- Cervical cancer is considered as the second most common gynecological tumor world-wide. It is considered the leading cause of death from gynecological cancers.
- The incidence of cervical cancer is decreasing in the developed countries but continues to rise in developing countries.
- Cervical cancer may take years to develop and with modern treatment, it is totally preventable with advancements in screening, diagnosis, etc.
SYMPTOMS AND PRESENTATION:
Some of the common presentations of cervical cancer include the following,
- The most common presentation is an abnormal smear test.
In some cases where there is locally advanced disease the presentation may be as follows,
- Vaginal bleeding and discomfort.
- Discharge or symptoms attributable to the involvement of adjacent structures such as bladder, rectal or pelvic wall
- Occasional presentation of distant metastasis to bone and lung are common.
Studies show that,
- There is a strong association between cervical cancer and sexual activity. This includes sex at a young age and multiple sexual partners
- Infection with HPV (Human Papilloma Virus) has an important causal role. This has underpinned the introduction of programs to immunize teenagers against HPV in an effort to prevent the later development of cervical cancer. More than 99% of cervical cancer begins when the human papillomavirus infects the cervical tissues.
- The infection begins when the HPV virus inserts the viral DNA into the basal cells of the cervical tissue. Once it gets into the cell, the virus will produce more copies of the DNA.
- The majority of the HPV infections will clear on their own and they are highly transient. But in some high-risk cases such as in HPV 16 or 18, they are likely to persist.
- As the cervical cells divide, the infection spreads, and new viral particles are released. Over time, if the infection is persistent the HPV DNA initiates cellular changes. This causes the cell to look and behave abnormally.
- Transforming HPV infections may lead to pre-cancerous changes in the cervical tissue. If left undetected the pre-cancerous changes may lead to cervical cancer.
INVESTIGATION FOR CERVICAL CANCER:
Diagnosis is usually done by smear or cone biopsy
- Dilation and curettage are also used diagnostically along with cystoscopy and flexible sigmoidoscopy if there are symptoms referable to the bladder, colon, or rectum.
- MRI is often used to characterize the primary tumor
- A routine chest X-ray is done to rule out pulmonary metastasis
- CT of the abdomen and pelvis is done to rule out metastasis in the liver and lymph nodes to exclude hydronephrosis and hydro ureter.
MANAGEMENT OF CERVICAL CANCER:
As with any other cancer, the management of cervical cancer depends on the stage of the disease. The age of the patient, tumor volume, fitness of the patient, fertility concerns, and experience and resources available also play a role.
The usual treatment options of surgery, chemotherapy, and radiation therapy are followed based on the stage of the disease.
SURGICAL OPTIONS INCLUDE THE FOLLOWING
- During early-stage 1A- a procedure called ‘conization’- LEEP in which a cone-shaped portion of the cervix is removed and a thin wire heated by electricity is used to remove the tissue. A total hysterectomy could also be performed. This involves removing both the uterus and the cervix
- During later stages of 1A OR 1B- A procedure called radical trachelectomy is performed to preserve the uterus (in women of child-bearing age or women who would like to conceive in the later stages). In this procedure, the surgeon removes the cervix and the upper part of the vagina and a stitch is placed on the lower part of the uterus to act as an artificial internal opening of the cervix. Another option includes performing a radical hysterectomy where the cervix, the tissue around the cervix, the uterus, and part of the vagina.
- It is also important to understand that during a total or a radical hysterectomy the surgeon may also remove the other tissues like the fallopian tube, ovaries, or lymph nodes as necessary.
- The pre-malignant disease can be treated with laser ablation or diathermy, whereas in micro-invasive disease a large-loop excision of the transformation zone (LLETZ) or a simple hysterectomy is employed.
- The invasive but localized disease requires radical surgery, while chemotherapy and radiotherapy, including brachytherapy, may be given as primary treatment, especially in patients with adverse prognostic features such as bulky or locally advanced disease, or lymph nodes, or parametrium invasion. In metastatic disease, cisplatin-based drugtherapy may be beneficial in improving symptoms but does not improve survival significantly.
- In advanced cases, palliative chemotherapy and treatment are some options.
RECURRENCE OF THE CANCER:
In case of recurrence of the cancer, the surgical option followed is,
Many organs and tissues are removed in a hysterectomy. Some of the organs include the pelvic lymph nodes, bladder, vagina, rectum, and colon depending on where cancer has spread.
Even though a lot of options are available for the treatment of cervical and breast cancer, they do come to their fair share of pros and cons. Hence, it’s better to know your body thoroughly and get regular screenings done (if you are under the risk categories like, prone to cervical or breast cancer due to various reasons, family history of cervical or breast cancers, noticing changes in the body or the signs and symptoms that are associated with these cancers, etc.)
It is always better to have an awareness and learn to do a self-examination. Prevention is better than cure. Because the body is never going to be the same after an episode of a disease or a condition.