Dr. Madhu Y C

Ovarian cancer is referred to as the cancer of the ovaries. The ovaries are a component of the female reproductive system. There are two ovaries located on either side of the uterus in a woman's body. Ovaries which are the organs responsible for producing egg cells also produce the hormones estrogen and progesterone. Ovarian cancer is a type of cancer which often goes undetected until it has spread all the way to the pelvis and the abdomen. However, it is also very difficult to treat the condition in its later stages which is why diagnosing ovarian cancer quickly is quintessential. Here is everything you need to know about ovarian cancer;

Symptoms:

1. No symptoms at first: Usually, in its early stages ovarian cancer does not cause any symptoms.
2. Abnormal bloating: Bloating is when your abdomen swells due to excess fluid or gas inside. Abnormal bloating is more frequently associated with irritable bowel syndrome or even constipation is a common symptom of ovarian cancer.
3. Feeling full quickly: This is also an associated symptom which has often been mistaken for constipation or irritable bowel syndrome.
4. Weight loss: This is one of the more common signs of ovarian cancer.
5. Discomfort in the pelvis area: This symptom occurs towards the later stages of ovarian cancer after it has already spread.
6. Constipation: Constipation is a symptom of ovarian cancer as well.
7. Frequent urination: This is yet another symptom which is a sign of ovarian cancer.

The symptoms of ovarian cancer are often mistaken with that of irritable bowel syndrome and constipation.

Causes: As with other forms of cancer, it is still very unclear what exactly causes ovarian cancer.

Treatment:

1. Surgery: Surgery most commonly involves removing large parts of the female reproductive system which includes the ovaries, the fallopian tubes, the uterus as well as the lymph nodes. The surgeon will also try and remove as many cancer cells as possible from the abdomen and pelvic areas.
2. Chemotherapy: Chemotherapy is usually done after surgery. It is usually performed so that the rest of the cancer cells are killed off. Chemotherapy drugs can be injected directly into the vein, abdominal cavity or sometimes even both.

Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood.

Lung cancer is the most common cause of death due to cancer in both men and women throughout the world. According to the U.S. National Cancer Institute, approximately one out of every 14 men and women in the U.S. is diagnosed with cancer of the lung at some point in their lifetime. Lung cancer is predominantly a disease of the elderly; almost 70% of people diagnosed with lung cancer are over 65 years of age, while less than 3% of lung cancers occur in people under 45 years of age.

What Causes Lung Cancer?

The development of lung cancer is strongly associated with cigarette smoking, approximately 90% of lung cancers are attributable to use of tobacco. Pipe and cigar smoking can also cause lung cancer, but the risk is not as high as with cigarette smoking. Tobacco smoke contains more than 4,000 chemical compounds, many of which are cancer causing (carcinogens). Passive smoking, i.e. the inhalation of tobacco smoke by non-smokers who live or work with smokers, is also an established risk factor for the development of lung cancer.

Genetic susceptibility (i.e. family history) may play a role in the development of lung cancer. Other causes of lung cancer include air pollution (from vehicles, industry, and power generation) and inhalation of asbestos fibres (usually in the workplace).

Lung Cancer Symptoms:

Early symptoms and signs of lung cancer:

There may be no symptoms at the onset of the disease. When present, common symptoms of lung cancer may include:

1. Coughing: This includes a persistent cough that doesn't go away or changes to a chronic smoker's cough, such as more coughing or pain.
2. Coughing up blood: Coughing up blood or rust-colored sputum (spit or phlegm) should always be discussed with your doctor.
3. Breathing Difficulties: Shortness of breath, wheezing or noisy breathing (called stridor) may all be signs of lung cancer.
4. Loss of Appetite: Many cancers cause changes in appetite, which may lead to unintended weight loss.
5. Fatigue: It is common to feel weak or excessively tired.
6. Recurring infections: Recurring infections, like bronchitis or pneumonia, may be one of the signs of lung cancer.

Signs of advanced stages of lung cancer: Advanced stages of lung cancer are often characterized by the spread of cancer to distant sites in the body. This may affect the bones, liver or brain. As other parts of the body are affected, new lung cancer symptoms may develop, including:

1. Bone pain
2. Swelling of the face, arms or neck
3. Headaches, dizziness or limbs that become weak or numb
4. Jaundice
5. Lumps in the neck or collar-bone region

Treatment: Treatment for cancer involves a combination of surgery to remove cancer cells, chemotherapy and radiation therapy to kill cancer cells. Lung cancer is incurable unless complete surgical removal of the tumour cells can be achieved. Surgery is the most effective treatment for lung cancer, but only a few percentage of lung cancers are suitable for surgery i.e. Stage I and II NSCLC and cancer that has not spread beyond the lung.

Radiation therapy may be used for both NSCLC and SCLC and is a good option for people who are not suitable for surgery or who refuse surgery. Chemotherapy is used for both NSCLC and SCLC. Chemotherapy drugs may be given alone or in combination with surgery or radiation therapy. Chemotherapy is the treatment of first choice for SCLC since it has usually spread extensively in the body by the time it has been diagnosed.

Also used in the treatment of lung cancer are targeted therapies. These are drugs (gefitinib and erlotinib) or antibodies (cetuximab, bevacizumab) that block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression. They are used in some patients with NSCLC that does not respond to standard chemotherapy.

Cancer

Cancer is an uncontrolled proliferation of transformed cells in any part of the body. Neoplasm or tumor are used variably to describe any swelling or new growth. Benign growths don't have the potential to spread to other organs or parts of the body while malignancy or malignant growths have uncontrolled proliferation and metastatic potential. Transformation is a multistep process with genetic alterations by which normal cells acquire malignant potential, uncontrolled proliferation capacity and capacity to spread to other parts of the body (metastasis) worldwide cancer is responsible for 1 in 8 deaths. Most common cancers are:

Men: oral cancer (in India), prostate, lung

Women: breast, cervix and endometrium, colorectal, lung


What causes cancer? cancer is usually multifactorial 


1. Age- more in age group greater than 60 yrs compared to younger age group

2. Obesity- body mass index greater than 30

3. Tobacco - cigarette, cigar, bidi, hookah, smokeless tobacco like gutka, zarda etc. There is no safe form of tobacco.

4. Pan masala and supari

5. Alcohol

6. Ultraviolet rays exposure

7. Radiation exposure

8. Genetic factors

9. Others- pollution, certain chemicals, infections


Prevention of cancer: 


1. Stay away from tobacco products

2. Eat healthy and daily physical activity- fresh fruits and vegetable are good, maintain optimal body weight

3. Be safe in sun

4. Cancer awareness and early detection: alarming signs are (caution)-
 

• Change in bowel or bladder habits
• A sore that will not heal
• Unusual discharge or bleeding
• Thickening or lump in the breast, testicles or elsewhere
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• A nagging cough or hoarseness

5. Cancer screening: screening is for healthy individuals with education. Rather than going for unnecessary blind tests, a programme for screening should be planned in consultation with your oncologist as requirements are different for different cancers and differ as per age groups and gender. Also, screening is not effective in all cancers. Cancer education and awareness have due importance. Some cancers in which screening has been shown to be effective includes breast, colon, rectum, cervix, prostate, lung in high-risk groups but as mentioned earlier it is planned with participation of both individual and oncologist.


Types of cancer treatment:


Cancer treatment is now a multidisciplinary management in which different surgical, medical and radiation oncologist plan treatment protocol for best possible chances of cure. Advancement in all these fields and their contribution in comprehensive management results in 25-30% improvement in cure rate over previous decades.
 

• Surgery: involves surgical principles to remove the tumor with adequate margins and possible draining lymph nodes regions. Improvements and understanding of surgical principles even make resection of distant disease or cure of stage iv disease in some selected cases.
• Chemotherapy: cytotoxic drugs are given either in injectable or oral forms which acts on uncontrolled cancer cells. Advances in this fields result in drugs with better efficacy and less side effect profile and at the same time resulting in better cancer control. Targetted therapy acts on specific pathways of cancer growth. Hormone therapy targets specific hormone receptors for controlling cancer.
• Radiation therapy: is the delivery of radiation generated by radioactive source over the region of cancer. More and more advances in radiation technologists are emerging like imrt, sbrt to focus radiation over the specific location so as to avoid toxic effect over surrounding area.

Today is the WORLD CANCER DAY and the theme of this year is "We can, I can".... Yes we all can battle the cancer. But the irony is that majority of women ignore early signs and symptoms of cancer and do not consult doctors in time. And even some of these cancers are preventable if proper action is taken. 

Ovarian Cancer- 

• What will you do if you feel gaseous distension (gas, bloating), acidity, constipation, change in bowel habit, decreased appetite, feeling of full stomach, weight loss and abdominal swellling? Majority of the women ignore these symptoms and take antacids before it is too late. But these are often symptoms of early ovarian cancer and thus if you ignore these symptoms, you are harming yourself. Ovarian cancer is difficult to treat if detected at late stage. But in early stage, it is curable. So, don't ignore these symptoms.
• Who are the women at risk of ovarian cancer- women who are not having baby, who themselves or close relatives (sister/ mother/ daughter) had history of cancer in breast/ ovary/ bowel/ uterus etc. But some women are at lower risk like those using Oral Contraceptive Pills- OCP(- the birth control pills can reduce the risk by 50%) and who had tubal ligation (permanent family lanning methods).
• If you had such risk factors, you must not avoid any such above mentioned symptoms. Rather you should consult gynecologist early. Ovarian cancer can be detected by ultrasound, CT scan, some blood tests (CA 125) and some cases biopsy may be needed. And remember, majority of the ovarian diseases are NOT cancer but you must be sure that it's not cancer causing your problem.
• If ovarian cancer is diagnosed, the treatment is surgery (to be done by expert personnels) and most of the women need chemotherapy.
• Ovarian cancer is common in elderly women but it can afect younger women also. So, all the women should take care of the above mentioned symptoms

Cancer of Cervix: Cervix is the mouth of the terus. In our country, this is the COMMONEST CANCER in GYNAECOLOGY affecting women whereas it is uncommon in the Western countries. The irony is that women die of this disease whereas it is TOTALLY PREVENTABLE

• It is caused by a virus (human papilloma virus- HPV) that is sexually transmitted (so afects sexually active women). But it has a peculiar feature that before cancer actually occurs, there is precancerous stage- when the cells of cervix shows some changes that we can detect and treat. So, if women regularly consult doctor (WHEN THEY DO NOT HAVE PROBLEMS), we can check if she is at risk of cervical cancer or not, by some simple tests (Pap Smear, HPV testing etc). Is such changes are found (that is not cancer) we can treat her so that she does not develop cancer. These method of detection, before disease occurs or before an individual feels that she is having disease, is called "Screening". 
• Another method of preventing it is vaccination of HPV, that should be given to the adolescent girls before they become sexually active. Even it can be given in older women (who are sexually active), although the response is somehow lower than if given at early age. But vaccination is not alternative to screening. SO, both screening and vaccination should be done to prevent this cancer.
• Even if detected at early stage, it is totally curable. So, women should not ignore symptoms of excessive vaginal discharge (remember, all excessive discharges are not due to cancer), abnormal or heavy menstrual bleeding, bleeding occuring unredictably in between menstrualtion, bleeding after intercourse etc.
• It is treated by surgery and some cases may need radiation also.

Cancer of uterus

• Cancer of uterus is common after 50 years of age (although can occur at early years also). It is the commonest gynaecological cancer in the Western World. It mainly occurs in women who are obese (excessive weight), having diabetes or hypertension (high blood pressure), not having any baby, who are having personal or family history of cancer in uterus/ breast/ ovary/ bowel. 
• It can be prevented by taking OCP (birth control pils) and controlling weight. In many cases, it is also preceeded by some precancerous changes (hyperplasia) that can be detected by ultrasonography and if needed small biopsy procedure.
• The common symptoms are abnormal heavy bleeding and bleeding after attaining menopause (after totall stoppage of menses). So, any abnormal menstrual bleeding must be properly investigated.
• It is usually well curable if treated early- by surgery and in few cases, may need radiation, chemo or hormone therapy.

Cancer of Vulva: The external genitalia of female is known as vulva. Cancer in vulva is relatively uncommon but still it can happen, especially those who are having diabetes, HIV positive or those having poor hygiene.

• Never ignore any symptoms of excessive itching in your private parts. It may be the early symptom of vulval cancer. Some cases, patient may have ulcer or tumour or bleeding.
• It can be detected easily by examination by doctor and then taking biopsy. It is treated well with surgery and some cases, radiation may be needed.

Sumary: Majority of the gynaecological cacers are preventable. They can be diagnosed early if women consult doctor at early stage. Majority of them respond to treatment. 

One of the most common problems faced by ageing men is benign prostatic hypertrophy. Prostate is the gland at the base of the urethra near the bladder and when it enlarges it can lead to symptoms, mostly related to urination.

1. Frequent urge to pass urine
2. Prolonged urination
3. Frequent nocturnal visits to the toilet
4. Intermittent urination
5. Difficulty to start urinating
6. Inability to completely empty the bladder
7. Urinary tract infections

There are medications available to manage this, but offer only temporary relief. Many men therefore prefer to have the surgery undergone to manage these bothersome symptoms. However, like any surgery, the risks and benefits need to be considered along with other conditions like age, overall health status, other comorbid conditions, etc.

Surgical removal of the enlarged prostate gland is a more definitive approach to manage these symptoms. In addition to providing a quick cure, it also is used in the following cases:

1. Patients who do not respond to medications
2. Presence of blood in the urine
3. Associated bladder stones
4. Frequent infections of the urinary tract
5. Associated damage to the kidneys

Procedure of Surgery
During the procedure, a tube is passed through the tip of the penis into the urethra towards the bladder neck. Once it is in the desired position, laser is passed through it to deliver energy that acts on the prostate to either completely or partially destroy it. There are two methods by which laser acts on the enlarged prostate and making way for free flow of the urine.

1. Ablation: Excess prostate tissue is melted away by the laser by using photosensitive vaporization of the prostate. This is also known as Greenlight laser therapy or KTP laser vaporization. Alternately, Holmium can be used as the source of laser energy to ablate the prostate tissue.

2. Enucleation: Excess prostate tissue is cut and teased out through the urethra. Holmium laser is used to resect the prostate into smaller pieces, which are then removed out through a resectoscope. Another technique uses a tissue morcellator which grinds the enlarged prostate into smaller pieces to enable easy retrieval.

More men now opt for laser prostate removal as it has the following advantages:

1. Reduced risk of bleeding: This becomes essentially important in patients who are on blood thinners.
3. Immediate symptom relief: As compared to medications, the relief is felt almost immediately after the surgery
4. No catheter: With laser surgery, a catheter may be required for less than 24 hours unlike in open surgical cases.

As noted above, as with any surgery, once enlarged prostate symptoms set in, have a detailed discussion with your doctor to identify if you are a suitable candidate for laser surgery. If you wish to discuss about any specific problem, you can consult a Urologist.