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Preventing Gynaecological Cancer
Cervical cancer:
This type of cancer makes up 6% of all malignant tumours in women, and is the 2 nd and 4 th most frequent cancer by region. There are early detection programmes with a pelvic exam and cytology, allowing us to detect a pre-malignant lesion called CIN. 66% of CIN turns into cervical cancer within 10 years if not treated.
Causes: The highest risk factor for the development of CIN and cervical cancer is the papillomavirus, specially the types 16 and 18. Other factors include smoking, sexual promiscuity, early start of sexual intercourse, the number of children and low socio-economic class. This is why we recommend periodic cytologies upon starting sexual relations.
Symptoms: Often the first symptom of cervical cancer is post-coital bleeding or between menstruations.
How is it diagnosed? The diagnosis is done with a cervical biopsy during a gynaecological exam.
Treatment: This depends on the size and stage in which the tumour is diagnosed. Small tumors detected early is treated surgically and occasionally with radiotherapy. In advanced stages, treatment is a combination of radiotherapy and chemotherapy.
Prognostic: Depending on its stage. Early detection of cervical cancer has 80-100% cure rate. Then periodical gynaecological revisions play an important role.
Endometrial cancer:
The uterine or womb is an organ covered with a tissue called the endometrium. Up to menopause, the endometrium is renewed monthly during menstruation. Uterine cancer (endometrial cancer) usually develops due to changes in the endometrium. It often appears in the years prior to or after menopause, not often occurring in women younger than 40 years old.
Causes: There are some factors associated with the appearance of this cancer (family history, menopause after 52 years old, not having children, overweight, diabetes, obesity and high blood pressure. Hormone replacement therapy in menopause does not provoke endometrium cancer if performed properly.
Symptoms: If a woman still has periods, the cancer makes these irregular or with a higher flow. If a woman no longer has periods, any vaginal bleeding is abnormal. Any menopausal woman should consult her gynaecologist when unexpected vaginal haemorrhaging occurs.
Diagnosis: The gynaecologist does a gynaecological exam, vaginal ultrasound and hysteroscopy and biopsy of the endometrium.
Treatment: This depends on the size, grade and extension of the cancerous tumor. In early stages of the disease, treatment involves a hysterectomy (removal of the uterus). Depending on the prognostic factors, it also involves post-surgical radiotherapy.
Prognostic: The probabilities of the cure are 90% in tumour's detected early.
Ovarian cancer:
Ovarian cancer arises usually from a malignant transformation of the epithelial cells covering the ovary.
Causes: Currently the origin and cause of ovarian cancer is unknown. However, it is known that various hormonal and reproductive factors may favour it: infertility and a low rate of pregnancy. Genetic factors only determine around 10-15% of the cases. Breast cancer is often associated in the same family as ovarian cancer, and sometimes even found in the same person. Some environmental factors are also suspect, including fat intake, the use of talcum powder or some viruses which may influence the appearance of this disease.
We estimate that 1.5% of women are diagnosed with this cancer at sometime in their lives. The large majority of cases occur after menopause.
Symptoms: These are very scarce, often becoming large before instigating them. The most common symptoms are the feeling of weight in the pelvis, the frequent need to urinate, a mass in the pelvis and an increase in abdominal perimeter with a stretching sensation.
Diagnosis: This is often suspected when a pelvic mass is detected in a routine gynaecological exam. The suspicion is stronger with a gynaecological ultrasound, TAC scan and an MRI, along with a blood test called the Ca 125. It can only be confirmed with an operation.
Treatment: The factor that most conditions the chance for success is a surgery to completely eliminate the tumour. In young women who want to have children, and with tumours found early, there is the possibility of a conservative surgery that preserves fertility. Except with non-aggressive tumours and when detected very early, chemotherapy is always given after the operation.
Prognostic: Ovarian cancer in its early stages is now curable. Along with the advances in treatment, lowering mortality from this disease comes with prevention and early detection.
Prevention: Ovarian cancer is less frequent in women who have had several children. It is also less frequent in women that have taken oral anovulatories for years. Very at risk women include those with hereditary breast and ovarian cancer (BRCA) which may require removing both ovaries upon reaching 35 after having had the offspring desired.
Breast cancer:
Breast cancer is an abnormal and unorganized growth of the glandular breast tissue.
Symptoms: In early stages there are rarely symptoms. Breast pain is NOT a sign of cancer. The first sign is usually a lump that when touched feels different than the surrounding breast tissue. On occasions there are changes of colour and stretching of the skin of the affected areas. Other possible signs include: Pain or retracting nipple, skin irritation or cracking, inflamed breasts, reddening or scaling of the skin or nipple, or a bloody secretion from the nipple.
Risk factors:
Sex: It mainly affects women.
Age: 60% of the breast tumours occur in women older than 60.
Heredity: When a direct family member has had breast cancer, the risk doubles. Women with the BRCA1 and BRCA2 genes have a 50% greater risk of developing cancer before they're 70.
Personal history: Having had a benign breast tumour increases the risk in women that have many mammary ducts.
Race: White women are more prone to this cancer.
Menstrual periods: the sooner one begins menstruation the greater the risk. Women with a late menopause also have a greater risk.
Prolonged usage of contraceptives: Recent studies have shown that a prolonged use of contraceptives is not associated with breast cancer.
Hormone replacement therapy: This therapy seems to increase the long term (more than 10 years) risk of breast cancer, even though studies are not conclusive.
Alcohol: Long term alcohol consumption is clearly linked to a high risk of breast cancer.
Excess weight: Excess weight appears to be related to a higher risk of this disease.
However, we must be aware that between 70 and 80% of all breast cancers appear in women without any applicable risks.
Diagnosis:
Self-examination: This allows one to detect smaller tumours since the woman is familiar with her breasts and can detect any small changes.
Mammography: This is the diagnosis test par excellence. Women at risk should have a mammography and a physical yearly after the age of 40. Women not at risk should have a mammography every 2 years after the age of 40. Mammographies done every 2 years reduce the diseases´ mortality 25 to 35% in women 50 or older without symptoms.
Breast ultrasound: This is a secondary technique when diagnosing breast cancer. It differentiates between solid and liquid.
MRI: This allows for viewing the tumour's vascularisation.
TAC: this allows for diagnosing metastases.
PET: with radioactive tracers it locates the areas of the body where the tumour is.
Thermography: Not often used. It uses changes in temperature.
Biopsy: This is necessary to confirm the diagnosis.
Treatment: This depends on the stage in which the tumour is at. With early detection and the new techniques on the sentinel ganglion, nowadays most tumours can be treated with conservative surgery without the need to remove the whole breast. In these cases in which it is necessary to remove the whole breast, depending on the type and stage of the tumour, it can be immediately followed by reconstructive surgery that limits the physical and psychological effects on women.
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