Dr. Rajiv

Breast Cancer Prevention:

1. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

2. Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including:

3. Changing lifestyle or eating habits. Avoiding things known to cause cancer. Taking medicine to treat a precancerous condition or to keep cancer from starting.

General information about breast cancer:

Key points:

1. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Breast cancer is the second most common type of cancer in india

2. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

3. The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

4. Enlarge Drawing of female breast anatomy showing the lymph nodes, nipple, areola, chest wall, ribs, muscle, fatty tissue, lobe, ducts, and lobules.

5. Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.

6. Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

    

Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer:

1. Older agea personal history of breast cancer or benign (noncancer) breast diseasea family history of breast cancerinherited gene changesdense breasts

2. Exposure of breast tissue to estrogen made in the bodytaking hormone therapy for symptoms of menopause radiation therapy

The following are protective factors for breast cancer:

1. Less exposure of breast tissue to estrogen made by the bodytaking estrogen-only hormone therapy after hysterectomy,

2. Estrogen-only hormone therapy after hysterectomyselective estrogen receptor modulatorsaromatase inhibitors and inactivators

3. Risk-reducing mastectomy ovarian ablationgetting enough exercise

It is not clear whether the following affect the risk of breast cancer:

1. Oral contraceptives

2. Factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk

Older age:

1. Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

2. A personal history of breast cancer or benign (noncancer) breast disease

    

Women with any of the following have an increased risk of breast cancer:

1. A personal history of invasive breast cancer, ductal carcinoma in situ (dcis), or lobular carcinoma in situ (lcis). A personal history of benign (noncancer) breast disease.

2. A family history of breast cancer

3. Women with a family history of breast cancer in a first-degree relative (mother, sister, or daughter) have an increased risk of breast cancer.

Inherited gene changes:

1. Women who have inherited changes in the brca1 and brca2 genes or in certain other genes have a higher risk of breast cancer, ovarian cancer, and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors.

2. Men who have inherited certain changes in the brca2 gene have a higher risk of breast, prostate, and pancreatic cancers, and lymphoma.

Dense breasts:

1. Having breast tissue that is dense on a mammogram is a factor in breast cancer risk. The level of risk depends on how dense the breast tissue is. Women with very dense breasts have a higher risk of breast cancer than women with low breast density.

2. Increased breast density is often an inherited trait, but it may also occur in women who have not had children, have a first pregnancy late in life, take postmenopausal hormones, or drink alcohol.

3. Exposure of breast tissue to estrogen made in the body

4. Estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating.

A woman's exposure to estrogen is increased in the following ways:

Early menstruation: beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen. Starting menopause at a later age: the more years a woman menstruates, the longer her breast tissue is exposed to estrogen. Older age at first birth or never having given birth: because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant.

Taking hormone therapy for symptoms of menopause:

Hormones, such as estrogen and progesterone, can be made into a pill form in a laboratory. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (hrt) or hormone therapy (ht). Combination hrt/ht is estrogen combined with progestin. This type of hrt/ht increases the risk of breast cancer. Studies show that when women stop taking estrogen combined with progestin, the risk of breast cancer decreases.

Radiation therapy to the breast or chest:

1. Radiation therapy to the chest for the treatment of cancer increases the risk of breast cancer, starting 10 years after treatment. The risk of breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty, when breasts are forming.

2. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast.

3. For women who have inherited changes in the brca1 and brca2 genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed before 20 years of age.

Obesity:

Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy.

Drinking alcohol:

Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises.

The following are protective factors for breast cancer:

1. Less exposure of breast tissue to estrogen made by the body

2. Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:

Early pregnancy: estrogen levels are lower during pregnancy. Women who have a full-term pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breast-feeding: estrogen levels may remain lower while a woman is breast-feeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed.

Taking estrogen-only hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators

Estrogen-only hormone therapy after hysterectomy

Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogen-only therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy.

Selective estrogen receptor modulators:

Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (serms). Serms act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues.

Treatment with tamoxifen lowers the risk of estrogen receptor-positive (er-positive) breast cancer and ductal carcinoma in situ in premenopausal and postmenopausal women at high risk. Treatment with raloxifene also lowers the risk of breast cancer in postmenopausal women. With either drug, the reduced risk lasts for several years or longer after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene.

Taking tamoxifen increases the risk of hot flashes, endometrial cancer, stroke, cataracts, and blood clots (especially in the lungs and legs). The risk of having these problems increases with age. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. The risk of having these problems decreases after tamoxifen is stopped.

Taking raloxifene increases the risk of blood clots in the lungs and legs, but does not appear to increase the risk of endometrial cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women who have a high or low risk of breast cancer. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Talk with your doctor about the risks and benefits of taking this drug.

Aromatase inhibitors and inactivators:

Aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of a new breast cancer in women who have a history of breast cancer. Aromatase inhibitors also decrease the risk of breast cancer in women with the following conditions:

Postmenopausal women with a personal history of breast cancer. Women with no personal history of breast cancer who are 60 years and older, have a history of ductal carcinoma in situ with mastectomy, or have a high risk of breast cancer based on the gail model tool (a tool used to estimate the risk of breast cancer).

In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Aromatase inactivators stop the enzyme from working.

Possible harms from taking aromatase inhibitors include muscle and joint pain, osteoporosis, hot flashes, and feeling very tired.

Risk-reducing mastectomy:

Some women who have a high risk of breast cancer may choose to have a risk-reducing mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision.

Ovarian ablation:

The ovaries make most of the estrogen that is made by the body. Treatments that stop or lower the amount of estrogen made by the ovaries include surgery to remove the ovaries, radiation therapy, or taking certain drugs. This is called ovarian ablation.

Premenopausal women who have a high risk of breast cancer due to certain changes in the brca1 and brca2 genes may choose to have a risk-reducing oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Risk-reducing oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density.

Getting enough exercise:

Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight.

It is not clear whether the following affect the risk of breast cancer:

1. Oral contraceptives

2. Certain oral contraceptives contain estrogen. Some studies have shown that taking oral contraceptives (" the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Other studies have not shown an increased risk of breast cancer in women who take oral contraceptives.

3. Progestin -only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. More studies are needed to know whether progestin-only oral contraceptives increase the risk of breast cancer.

Environment

1. Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer.

2. Studies have shown that some factors do not affect the risk of breast cancer.

The following do not affect the risk of breast cancer:

1. Having an abortion. Making diet changes such as eating less fat or more fruits and vegetables. Taking vitamins, including fenretinide (a type of vitamin a). Cigarette smoking, both active and passive (inhaling secondhand smoke). Using underarm deodorant or antiperspirant. Taking statins (cholesterol -lowering drugs). Taking bisphosphonates (drugs used to treat osteoporosis and hypercalcemia) by mouth or by intravenous infusion.

2. Cancer prevention clinical trials are used to study ways to prevent cancer.

Uterine cancer is also known as endometrial cancer. It is a cancer which begins in the lining of the uterus. The uterus is the part of a woman's body where the fetus develops. Uterine cancer is one of those rare cancers in India, which can be diagnosed in its early stages. This is because excessive vaginal bleeding occurs, thus making it a very serious and an apparent symptom. It is also one of the few forms of cancer which can be cured as removing the uterus is often more than enough to cure the patient of uterine cancer.

Here are the causes, diagnosis and treatment of uterine cancer:

Causes:

The exact cause of uterine cancer is not yet known, however, there is a theory on what causes uterine cancer. Hormones in a woman's body have been thought to increase the chances of getting uterine cancer. This is because it has long been thought that having high levels of estrogen is the cause of uterine cancer. Increased estrogen thickens the endometrium and thus, increases the likelihood of uterine cancer.

Diagnosis:

1. Pelvic exam: This is an examination in which the vagina, bladder, rectum and uterus are scanned for lumps. If they are found, it might be due to uterine cancer.

Treatment:

1. Surgery: This is the most common treatment as it removes the entire uterus and prevents the spreading of the cancer.
2. Chemotherapy: Chemotherapy involves giving drugs which kill cancerous cells. They are given through either an intravenous line or even in pill form.
3. Hormone therapy: This is a therapy in which either progesterone levels are increased or estrogen levels are decreased.
4. Radiation therapy: In this treatment, high energy laser beams are used to destroy cancerous cells. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Bone cancer is a cancerous tumour in the bone, destroying the normal bone tissues. Tumours on bone tissues are not always cancerous or malignant, they are mostly benign. Primary bone cancer is when the malignant tumour begins to form in the tissues of the bones, but when these cancerous cells spread to other body parts like breasts, prostate or lungs, it is called metastatic cancer. Primary bone cancer is less common than metastatic cancer.

Bone cancer can be of three different types:

1. Osteosarcoma: In this case, the malignant tumour arises from the osteoid bone tissue. This occurs mainly in the upper arm and knee areas.

2. Chondrosarcoma: In this case the cancerous cells form in the cartilaginous tissues, causing a lot of pain. This occurs mostly in the pelvic area.

3. The Ewing sarcoma generally arises in the bone but it can also form in the soft tissues. Other kinds of soft tissues affecting cancerous cells are known as soft tissue sarcomas.

Causes-

There aren’t many clear defined causes; however, several factors have been identified by researchers.

1. Osteosarcoma is seen to occur more frequently in people who have been through a high external radiation therapy dose.

2. In people who have frequently been treated with anticancer medications, children tend to be most affected.

3. Heredity may be an adding cause, although the percentage of hereditary transfer of cancer cells is very low.

4. People with hereditary bone defects or implants have a higher chance of acquiring bone cancer.

Symptoms-

The most common and saddening symptom of bone cancer is painful, although not all bone cancers cause pain. Unusual or persistent swelling or pain around a bone maybe a red flag for bone cancer. In case of a situation like this, immediate doctor’s opinion is required.

Diagnosis-

Usually, diagnosis of a bone cancer can be made using X-rays; for example, a bone scan, a computed tomography scan, a magnetic imaging procedure—positron emission tomography, and an angiogram. Biopsy and blood tests are also helpful in bone cancer diagnosis.

Treatment-

The size, location and stage of cancer, age, and health of the person decide the kind of treatment that should be given to the patient. Various treatment options include chemotherapy, radiation therapy and cryosurgery.

Survival-

The combined survival rate of all sorts of bone cancers is 70%. This percentage may vary with the type of bone cancer and also its stage.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Fibroid tumour is the abnormal cell growth in the uterus and they are mostly benign. Fibroids usually affect women in the age bracket of 30 - 40. Fibroid tumours are of three types, depending on their location:

1. Submucosal fibroids: The tumour develops under the lining of the uterus
2. Intramural fibroids: The growth is found amongst the muscles in the wall of the uterus
3. Subserosal fibroids: The growth develops on the wall of the uterus right in the pelvic cavity

Causes behind it
The exact cause of fibroids in not known clearly. But certain factors have been discovered that might influence their formation. These factors include:

1. Hormones: Progesterone and estrogen are the hormones responsible for recreating the uterine lining during every menstrual cycle. These hormones might trigger the formation of tumour.
2. Family history: If any member in your family; your mother, grandmother or sister has/had fibroids in their uterus, you may also develop it.
3. Pregnancy: Your body produces excessive progesterone and estrogen when you are pregnant, which may cause an increase in the size of a pre-existing small fibroid. Myomectomy can be done by giving incision on the abdomen or by laparoscopy depending on the size and location of the fibroids.

Signs You are suffering from it

1. Heavy bleeding along with blood clots during or between your periods
2. Lower back or pelvic pain
3. Elevated menstrual cramping
4. Frequent urination
5. Pain during sex
6. Longer than normal periods
7. Bloating or pressure in lower abdomen
8. Enlargement or swelling of the abdomen

How it can be treated?
Your doctor will formulate the right treatment depending on your age, the mass of the fibroids and your overall health. Your doctor may choose a combination of treatment to cure your fibroids, and they include:

1. Medication: Gonadotropin releasing hormones (GnRH) agonists, birth control pills and ibuprofen (anti-inflammatory medicine) are prescribed. GnRH agonists reduce the level of progesterone and estrogen in your uterus.
2. Surgery: Myomectomy and hysterectomy are two common surgical procedures to treat fibroids. Myomectomy is performed by removing the fibroids only by making an incision on the abdomen. But hysterectomy completely removes the uterus. The latter is reserved for serious cases.
3. Non-invasive surgery: Forced ultrasound surgery, myolysis (shrinking fibroids with laser or electric current), cryomyolysis (fibroids are frozen) and endometrial ablation (an instrument uses heat, hot water, microwaves or electric current to destroy fibroids) are some non-invasive surgical procedures. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.