CK Birla Hospital for Women

Hi,

I am Dr. Renu Keshan Mathur. Today I will talk about cancer of the cervix. Cervix is the mouth of the uterus. So, cancer of the cervix is the mouth of the uterus. It is one of the common cancers in women. And together with breast comprises more than half of the cancers in the women. It is caused by human papillomavirus. So, infection with the virus causes changes in the cells of the cervix which cause those cells to become cancerous. The factors which cause predispose to the cancer are increasing exposure to the virus which would be early sexual contact. Because in early-stage cells are more likely to convert into cancerous. Multiple sexual partners increase the risk for the same. Different type of sexually transmitted disease like HIV, syphilis, gonorrhea which causes cervical cancer. A weak immune system, like a woman, is undergoing any radiotherapy, chemotherapy or some immunosuppression therapy for any other disease can cause body lower immune. Smoking causes changes cells to the cervix which predispose to become easily infected by the human papillomavirus.

So, these are the causes of cancer to the cervix. Clinical symptoms are usually, bleeding after intercourse, post contact bleeding should never be ignored. It should always be followed up. A foul-smelling bloody discharge at any time irrespective of intercourse should be evaluated for the cancer of the cervix. Constant pelvic pain is again one of the signs. Pre-cancerous symptoms are seen in many women in the late 20s and 30s. However, the progression of the disease is so slow that by the time the patient presents to Dr, she is usually 40+. She usually comes with bleeding after intercourse or in between the periods a bloody foul-smelling discharge. So, there are some tests to screen to rule out cancer which should be done by all women who are sexually active after the age of 30-32. It should be done routinely. One is pap-smear. It is a non-invasive procedure which we take cells from the mouth of the uterus and they are sent to the lab to see any change.

For suspicious lesions on the cervix, we do a colposcopy. It is an advanced procedure. It is done as a daycare procedure. But for diagnosis, we have to take the biopsy of the affected part or the suspicious part. So, for that, we take the punch biopsy or a cone biopsy in which we get a wider amount of tissue. Endocervical can also be done in which we take cells from the inner lining of the cervix. So, these are the tests for cervical cancer. Now, once we have diagnosed cervical cancer, what is the treatment? The treatment is the simple hysterectomy, it happens on the staging. Like other cancers, there are stages. If it spreads to the liver, peritoneal tissues or the uterus, then it is called different staging. If more tissues are involved then we have to do a radical hysterectomy which means removing the cervix, uterus, the ovaries and the tubes and also a lot of the pelvic tissues.

If the disease is too far spread then we can only do radiotherapy or chemotherapy. Is there any way to prevent cervical cancer. Yes. Avoidance of all these factors which leads to the pre-exposure of the human papillomavirus-like multiple sexual partners, using a contraceptive i.e. condom, is helpful in preventing human papillomavirus. Now, stopping smoking really helps. One important way which is now available to all of us is the vaccination. If the vaccination is taken, then even exposure to the virus does not cause the disease. The vaccine is given between the age of 9 and 47. And if the young girl is given before the age of 15, she can just take 2 doses. If it is given at the last age then 3 doses are required at 0-2 and 6 months, and 0-2 for the younger girls before the age of 15. So, this should be easily available everywhere and it should be given. And many people not lightly to take that because it is a little expensive. But at the same time, spending money to prevent a major disease, later on, I think is really worthwhile. So, with a little bit of care, screening and vaccination, we can prevent the occurance of cervical cancer.

Thank You!

Hello! I am Dr Renu Mathur Keshan. I will today be talking about recurrent pregnancy loss. I am a gynaecologist so that is my topic. It’s a very traumatic condition- Recurrent Pregnancy Loss. It affects about 2 to 5% of all married couples. And 2 or more abortions in less than 20 weeks of gestation that is less than 5 months is called a recurrent pregnancy loss. It is becoming very common nowadays as marriages are late so people are under stress and they want to have a baby soon that makes them more stressed out. But the main causes actually are uterine abnormalities. If the shape of the uterus is not okay which is a genetic formative condition – not much can be done about it on the patient side, that causes the pregnancy to get aborted at an early age.

Another common cause is autoimmune diseases which are called antiphospholipid diseases. Metabolic & hormonal diseases which are uncontrolled can also cause this problem. And the 4th common cause is Genetic formations which are when there is something wrong in the formation of the baby. This is very troublesome for the patient as well as the doctor because the patient is already stressed out. The lifestyle is bad nowadays that causes a problem, the patients are not getting enough rest, there is a tendency to be involved in junk foods & women are drinking and smoking – so all these things have to be changed. When a pregnancy is planned, ideally 2 to 3 months before, a lady should start taking folic acid and try to switch over to a healthy lifestyle which would include taking green vegetables & fruits, protein-rich diet, abstain from alcohol & smoking. A little bit of exercise would also help. Now once this happens the patient is very stressed out, this does not mean it's going to happen in the subsequent pregnancies also but care has to be taken. So now about the treatment modalities. If we are clearly able to demonstrate that there is a formation defect in the uterus which is not allowing the pregnancy to go on normally then surgical management is done to alter the condition of the uterus whether it is the shape, whether it is an extra membrane in between that can all be resolved surgically.

Then subsequent pregnancies will be successful. Hormone support is given if there is any hormone imbalance. Usually, progesterone is given. Then uncontrolled diabetes & uncontrolled hypothyroidism will be treated and control on the diseases will cause the pregnancy to be successful. For antiphospholipid syndrome which is an autoimmune disease, heparin is very successful in the treatment of that. But a lot of contribution is made by the patient side, reassurance from the doctor and the support of the family. Rest would be required, a healthy lifestyle is required. Now people will always ask what will we have a normal delivery? I think that is a very late stage to concern yourself with. Go ahead with a healthy pregnancy and then we can talk about it. I think that takes care of all about recurrent pregnancy losses, causes and its treatment. Thank you!