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Good morning, I am Dr Dinesh Singh I am director predation oncology at Max hospital, Vaishali and today I will be talking about the most common cancer of women in India, it is breast cancer and there is no age bar. We have seen patients as young as 17 to 18 years and as old as 80 to 90 years. So every woman is at risk of getting the breast cancer, now which are the ladies which are more prone to get breast cancer when those ladies who do not have the breastfed their child, those who are very obese or those who have history of a breast cancer in their first relative like in the father, mausi, sister they are at higher risk, but then any population is at risk of developing cancer. What we need to understand is that we should be aware about our body and we should do a self breast examination every month, so that we know the change which happens in our breast over a period of time and once you notice that there is a lump in the breast, usually, pain is not initial symptom of Cancer any cancer in the body and whenever you notice that there is a lump in the breast then it has to be further investigated. The age is less than 40 years we go for an ultrasound of the breast which is more than 40 years we go for mammography of the breast. And then further investigation like a biopsy of the lump and if it is found cancerous, then we do for the test to see whether it is spread to another part of the body or not. Well, that tells us about the stage the breast cancer is and then depending upon the stage the treatment is decided. That let us say that we diagnose breast cancer at a very early stage that means it is less than 3 to 4 cm and at that time we do not need to remove the entire breast of the person to cure the person, we can remove only a portion the cancerous portion plus a little bit of arching around the tumor and in the axilla we have to do surgery to get out the nodes. For that now it is a sentinel node biopsy is done what happens in that is that we identify the draining lymph nodes we take them no we study them then and there when the patient is still under anaesthesia and if they are not cancerous then we do not take out the further lymph nodes of the axilla, if they are cancerous then we take them out. After that then the further treatments depends upon the final histopathology report of the tumor, if the tumor is very small If in case very sensitive to hormones these patients don't need any chemotherapy, radiotherapy becomes a part of the every breast conservation surgery and if that tumor is larger or it is not sensitive to hormones then we have to give chemotherapy. In chemotherapy now very latest medicines are available there are called targeted therapy and the cure rates have become very high. All the cancers especially breast cancer the side effects are very minimal, we have all the medicines which can take care of the vomiting, the infection and other side effects which are happening along with the chemotherapy. And regarding radiotherapy, the latest technology is targeted radiation or image-guided radiation along with other things we are able to do a very pinpoint radiation to the area where it should go. So that it saves the underline normal structures from getting exposed to radiations the cure rates become very high and the side effects are very low. So I will say that all the girls and all the ladies they should do a self-examination try to be familiar with their normal body oncology, diagnose cancer early to treat it properly and be the cure of cancer. Thank you.
The uterus or womb, is a muscular structure and is held in place by ligaments and pelvic muscles. If these muscles or tendons become weak, they cause prolapse and are no longer able to hold the uterus in its place.
Uterine prolapse happens when the uterus falls or slips from its ordinary position and into the vagina or birth waterway. It could be complete prolapse or even incomplete at times. A fragmented prolapse happens when the uterus is just hanging into the vagina. A complete prolapse depicts a circumstance in which the uterus falls so far down that some tissue rests outside of the vagina. Likewise, as a lady ages and with a loss of the hormone estrogen, her uterus can drop into the vaginal canal. This condition is known as a prolapsed uterus.
Risks: The risks of this condition are many and have been enumerated as follows:
- Complicated delivery during pregnancy
- Weak pelvic muscle
- Loss of tissue after menopause and loss of common estrogen
- Expanded weight in the stomach area, for example, endless cough, constipation, pelvic tumors or accumulation of liquid in the guts
- Being overweight
- Obesity causing extra strain on the muscles
- Real surgery in the pelvic zone
Symptoms: Some of the most common symptoms of prolapse involve:
- Feeling of sitting on a ball
- Abnormal vaginal bleeding
- Increase in discharge
- Problems while performing sexual intercourse
- Seeing the uterus coming out of the vagina
- A pulling or full feeling in the pelvis
- Bladder infections
Nonsurgical medications include:
- Losing weight and getting in shape to take stress off of pelvic structures
- Maintaining a distance from truly difficult work
- Doing Kegel workouts, which are pelvic floor practices that strengthen the vaginal muscles. This can be done at any time, even while sitting down at a desk.
- Taking estrogen treatment especially during menopause
- Wearing a pessary, which is a gadget embedded into the vagina that fits under the cervix and pushes up to settle the uterus and cervix
- Indulging in normal physical activity
Some specialists use the following methods to diagnose the problem:
- The specialist will examine you in standing position keeping in mind you are resting and request that you to cough or strain to build the weight in your abdomen.
- Particular conditions, for example, ureteral block because of complete prolapse, may require an intravenous pyelogram (IVP) or renal sonography. Color is infused into your vein, and an X-ray is used to view the flow of color through your urinary bladder.
- An ultrasound might be utilised to rule out any other existing pelvic issues. In this test, a wand is used on your stomach area or embedded into your vagina to create images of the internal organ with sound waves. If you wish to discuss about any specific problem, you can consult a Gynaecologist.
Dilation and curettage procedure which is commonly referred to as D&C is a minor surgical procedure where the cervix is dilated while a special instrument is used for scraping out the lining of the uterus. It is important to know what you can expect before, after and during the process so that you can stay ahead of unnecessary worries and help the process to be smooth and fruitful.
When do doctors recommend dilation and curettage process?
You may be required to undergo the dilation and curettage procedure for one of many reasons. It can be used for removal of tissues in the uterus during or after an abortion or miscarriage or to remove little pieces of placenta after delivery. This process aids in preventing infection as well as heavy bleeding. On the other hand, it can help in diagnosing and treating abnormal uterine bleeding including polyps, fibroids, hormonal imbalances and even uterine cancer. A sample of the tissues in the uterus is tested under a microscope to check if there is any abnormal cell present.
What can you expect during the dilation and curettage process?
The D&C procedure is a minor one and takes about 15 minutes even though you will have to spend about 4 to 5 hours in the healthcare facility. Before the procedure, your doctor would check complete history, and at this point, you should tell your doctor if you suspect that you are pregnant, you are sensitive to latex or any medicines or if you have a history of bleeding disorders. You will then be given anesthesia so that you don’t feel any pain or discomfort during the procedure. Before this procedure, you will have to empty your bladder.
The D&C procedure comprises two main steps, dilation, and curettage.
Dilation involves opening of the lower part of the uterus or the cervix for allowing insertion of a slender rod. This is done to soften the cervix so that it opens and allows curettage to be performed. Curettage involves scraping of the lining and removal of the uterine contents with the help of a spoon-like instrument known as a curette. This may cause some amount of cramping, and a tissue sample would be taken out for examination in the laboratory.
After the completion of the procedure, you may experience slight bleeding and cramping. In some rare cases, adhesions or scar tissues may start forming inside the uterus, and this condition is termed as Asherman’s syndrome which can cause changes in the menstrual cycle along with infertility. This problem, if arises, can be solved with the help of surgery and therefore, you should report any abnormality in your menstrual cycle to your doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!