#for example the woman had late-stage cervical cancer

[cesium-sheep]

ah dang obviously I'd heard about the fruity garlic lady before since I watched every episode of buzzfeed unsolved but apparently 1. it was the next town over from where arin is working now which. yknow. makes the described awful conditions of the hospital make sense lol, and 2. it's been solved in the time since the buzzfeed unsolved video about it.

[cancerhospital02]

lets fight cancer togeather

a cancer doctor in bhopal

https://cancerhospital.org.in/gallery

What is Cancer?

 Cancer is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells, or tumor cells. Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, lung cancer, colon cancer). Cancer is not confined to humans; animals and other living organisms can get cancer. Below is a schematic that shows normal cell division and how when a cell is damaged or altered without repair to its system, the cell usually dies. Also shown is what occurs when such damaged or unrepaired cells do not die and become cancer cells and show uncontrolled division and growth – a mass of cancer cells develop. Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastasis. For example, if breast cancer cells spread to a bone, it means that the individual has metastatic breast cancer to bone. This is not the same as “bone cancer,” which would mean the cancer had started in the bone.

There are over 200 types of cancers; most can fit into the following categories according to the research:

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs.

Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.

Lymphoma and myeloma: Cancers that begin in the cells of the immune system.

Central nervous system cancers: Cancers that begin in the tissues of the brain and spinal cord.

How does cancer start?

Your body is made up of many different types of cells. Under normal conditions, cells grow, divide, become old, and die. Then, in most cases, they’re replaced by new cells. But sometimes cells mutate grow out of control, and form a mass, or tumor, instead of dying. Tumors can be benign (noncancerous) or malignant (cancerous). Cancerous tumors can attack and kill your body’s tissues. They can also spread to other parts of the body, causing new tumors to form there. This process is called metastasis and it represents cancer that has advanced to a late stage.

Warning Signal of Cancer: Remember CAUTION:

C  - Change in bowel or bladder habits A -A wound that does not heal U -Unusual bleeding or discharge T -Thickening or lump in the breast or elsewhere I - Indigestion or difficulty in swallowing O- Obvious change in a wart or mole N - Nagging cough or hoarseness of voice

Early Detection of Cancer

•        Create awareness about the early warning signs of cancer •        Encourage breast awareness •        Encourage oral self-examination •        Create awareness about symptoms of cervical cancer •        Examine, as a routine, the oral cavity of patients with history of tobacco use •        Offer clinical breast examination/ screening for cervical cancer to any woman over 30 years presenting to health facility. •        Promptly refer any person with a suspicious lesion for accurate diagnosis and treatment

a cancer doctor in bhopal

https://cancerhospital.org.in/gallery

[jghouse-asia-pacific]

New Post has been published on https://www.jg-house.com/2019/05/19/death-davao/

A Death in Davao

The house in Royal Valley was the same. With a doorway missing its door and a window frame without any glass panes, the tiny house offered little separation between an inside and an outside world. Moist sea air settled in the living room, bedroom, and kitchen. Noises were as loud in the bedroom as they were in the street. Animals from the neighborhood wandered in and then walked out. But the atmosphere on this late evening in October, I realized, despite the familiar sounds, was very different.

It was a Sunday, a few hours after sunset. A couple of hours before, I had exited a Cebu Pacific airplane and entered the terminal of the small airport 10 kilometers northeast of downtown Davao. I was back in the capital of Mindanao, the most impoverished and southernmost of the Philippines’ three principal islands.

Inside the living room, my eyes could detect only vague shapes in an almost complete darkness. After a few seconds, they were able to distinguish an object on the floor next to the wall. It was Jogie, lying on a mattress with her face turned toward the dark wall.

“I have a fever,” she said, turning back toward me and adjusting a square bandage on her forehead. She switched on a small, shadeless lamp next to the mattress. A single bulb cast an orange light in the moist air. Above her, attached to the wall, the new air-conditioning unit emitted cool air and a low humming sound. The machine was small, but effective. The air in the room was much cooler than it ever had been before. Usually the heat and humidity inside were extreme.

I sat in the same plastic chair I had occupied on prior visits. On this night in late October, though, I wondered if this visit would be my last. Jogie was fighting, but the problems arising from the cancer in her cervix were increasing. The pain was more severe; her voice, once so strong, now was much weaker.

Royal Valley, Davao, Philippines

Alarming Data

Jogie’s decline coincided with sobering news from recent reports on cancer. For example, the American Cancer Society and the pharmaceutical company, Merck, had released a study, “Global Burden of Cancer in Women.” The number of women who will die from cancer each year, according to the report, will rise from 3.5 million in 2012 to 5.5 million in 2030, an increase of 60 percent in two decades. Where many people had assumed the death rate would drop, with advances in medicine, it rose.

Cancer kills one in seven women worldwide, making it the second most lethal cause of death after cardiovascular disease. The report compared data for women with cancer in a developed country, such as the United States, to data for women with cancer in a developing country, such as the Philippines. In developed countries, breast, lung, and colorectal cancers were the most prevalent; in developing nations, breast, cervix, and lung malignancies were the most common. But in 39 of the poorest nations cervical cancer was at the top of the list.

Man, Cemetery, Davao

Grim Outlook

At 33, Jogie formerly had operated a modest business selling health and beauty products over the Internet.

The oldest of five children, Jogie had lost her father when she was nine. His death from a gunshot wound to the head was sudden. While her mother, a woman with little education, took whatever jobs she could to support the family, Jogie took care of her three sisters and one brother. When Jogie was 19, she decided to move to Japan to start a career in Tokyo’s karaoke bars. Then she learned the Japanese had cancelled the visa program for workers from the Philippines.

Jogie moved to Manila, the Philippine capital, on the island of Luzon, where she lived for the next 12 years, working in various call centers providing customer service. Now Jogie lay on a mattress under her mother’s roof, too sick to take care of herself.

Home, Royal Valley, Davao

Poverty

Globally, cervical cancer is the fourth most common cancer and the fourth leading cause of death among women. However, in poorer nations, it’s the second most common cancer and the third leading cause of death. In fact, almost 90 percent of all deaths due to cervical cancer occur in developing countries, such as the Philippines and Malawi, a country in southeastern Africa.

Medical researchers now consider the human papillomavirus, or HPV, transmitted through sexual intercourse, the cause of cervical cancer. More than a hundred types of HPV exist, but only a few of them cause cervical cancer. The International Agency for Research on Cancer has classified 12 types of HPV as carcinogenic for humans. Of these 12 types, HPV 16 and 18 are the most common, causing 70 percent of all cervical cancers.

Cookie, Royal Valley, Davao

Diagnosis

“Yesterday I went to the hospital,” said Jogie, “to get the results of my latest urinalysis. I have an infection.”

A small child burst into the room, almost falling with every step she took. It was Cookie, the daughter of Jogie’s youngest sister, Mabel. Suddenly the little girl stopped, three feet in front of me. She stared at me, uncertain what to do next. The last time I had seen Cookie she was not yet walking. Now her jet black hair reached almost to her shoulders, and her big brown eyes focused on me.

The catheter attached to Jogie deposited urine into the bag at her side. I watched the flow of yellow liquid. “But the urologist told me there was nothing he could do,” she said. “The only one who could help me now, he said, was the oncologist. I have cervical cancer, stage III b.”

Jogie, Suburbs, Davao

Life-Saving Test

Cervical cancer, like other forms of cancer afflicting women, is, however, preventable. A vaccine exists to protect women against HPV. Also, screening tests, such as the Papanicolaou or Pap test, enable doctors to detect and remove pre-cancerous lesions.

The two to three generations of women around the world who have not received the HPV vaccine or who already have been infected with HPV must rely on screening tests. For such women, the objective is to check for a lesion that can progress to cervical cancer if left untreated.

The Pap test is the conventional screening method, but access to it, as to the HPV vaccine, is not easy.

Two Girls, Supermarket, Davao

Treatment

For Jogie, no vaccine or screening test would help her now. She needed treatment for the cancer in stage three of its four-stage progression. With radiation therapy, the oncologist could shrink the tumor blocking the flow of urine. Until then, Jogie would not be able to urinate on her own.

Jogie finally had started radiation treatment. Three months had passed since doctors at Southern Philippines Medical Center, the government hospital in Davao, confirmed their diagnosis. But for weeks Jogie had languished on a bed in the cancer ward of the hospital, receiving only pain medication. The tumor had doubled in size.

Jogie, with no money, was not a priority.

Now, with funds from two aunts, one in the Philippines and one in Germany, Jogie was able to start radiation therapy. She had a radiation session once a day, five times per week at Davao Doctors Hospital, the most modern health care facility on the island of Mindanao. She was scheduled to have a total of 33 sessions of radiation therapy. Also, she was advised to have six sessions of chemotherapy and three sessions of brachytherapy.

But Jogie didn’t have enough money.

Two Women, Downtown, Davao

Rising Toll

The economic burden of cancer, according to the report from the American Cancer Society and Merck, is growing every year. Expenditures for the early detection of cancer and for treatment continue to climb.

Around the world, larger cities are more likely to have the infrastructure for cancer care, as well as a higher proportion of people who could afford the care. In rural areas and smaller towns, lower-income individuals are less likely to have access to cancer care.

Due to high costs, many chemotherapeutic agents are not part of essential medicine lists in poor countries. The median number of oncology-essential medicines in a recent study ranged from 11 in low-income countries to 18 in lower middle-income and 26 in upper-income nations.

Turkeys, Cemetery, Davao

Lost Hope

“The Baptist church next to SaveMore donated the air conditioner,” said Jogie. “Mama went to them and asked for help.” Jogie laughed. “I don’t think I could survive without the air conditioner. My stomach feels like it’s on fire after a radiation session. Once I have chemotherapy, the burning sensation will be even worse.”

“Arequa,” Jogie said, uttering a word in Bisaya. She was in pain. “I don’t know what I will do when the money for my treatment runs out.” She started to turn over on the mattress, then stopped, reaching down toward the catheter between her legs.

“My only hope is to make it through this month,” said Jogie. It was a Friday at the beginning of December. I was back in the primitive living room of the small structure on the outskirts of Davao City, in the southern Philippines. “In January, my health insurance benefits will renew with the new year,” she said.

For 2016, Jogie had exhausted her benefits from the Philippines’ national insurance program, called PhilHealth. Now she was able to pay for treatment only through charitable contributions. “I’ve completed 23 radiation sessions,” she said. “My oncologist says I need five more in December. The goal is to shrink my tumor to three centimeters by the end of the month and, then, in January to target it with high doses of chemotherapy.”

Jogie’s tumor had grown from four-and-a-half centimeters at the end of August, when Jogie received her diagnosis, to seven centimeters at the beginning of October, when she started receiving treatment.

“But I need $500,” she said.

Gravestone, Cemetery, Davao

Death

On March 13, 2019, Jogie died. She left behind a son, Kobe, 19, and a daughter, Kryztle, 17.

I never saw any of them again.

#LifeCulture, #Philippines #Culture, #Davao, #PublicHealth

[engnews24h]

Everything You Need to Know About Ovarian Health: Ovarian Cancer, Cyst and ROMA Index

Eng News 24h Everything You Need to Know About Ovarian Health: Ovarian Cancer, Cyst and ROMA Index

Of all gynecologic tumors, ovarian cancer has the highest mortality rate and is primarily due to the absence of early symptoms of the disease.

Ms Milos Radovic, MD, Obstetrician, Obstetrician, Head of the Department of Family Planning with GAK Višegradska Day Hospital, Clinic for Gynecology and Obstetrics, Clinical Center of Serbia

In addition, this disease is the fifth leading cause of cancer deaths in women. For this reason, it is a constant and great challenge for medicine, laboratory diagnosticians and researchers to develop new tests and methods with more successful results in diagnosing the early stage of this disease.

Also read this: The face detects the disease

Signs of ovarian cancer warning that need to be addressed are the following symptoms, if they are felt five to eight times a week – back pain, fatigue, flatulence and stomach pain, frequent urination, stool problems.

If any of the above symptoms persist for more than 20 days, a more serious examination of the ovary is required.

It is important to keep in mind that CA – 125, a tumor marker used to detect ovarian cancer, produces a false positive in at least 50 percent of cases.

Also read this: How hormones dictate changes in the body

The ROMA index is a statistical calculation of the risk of ovarian cancer that includes the values ​​of the tumor markers CA125 and HE4 and the reproductive status of a woman.

HE-4 together with CA 125 to fight ovarian tumors

HE-4 (human epididymis protein 4), CA 125 (carcinoma antigen 125)

Also read this: How to get pregnant after 40s

Disadvantages of CA 125:

Elevated in benign conditions

On its own, it is not a sensitive marker

Not sensitive in the initial stage of a malignant tumor

Also read this: How To Keep Pregnant With 40+

HE-4 + CA125

It is not elevated in benign conditions

The combination of these two markers increases to a considerable extent sensitivity

Sensitive and in the initial stage of a malignant tumor

ROMA> 12.9% = High risk of developing malignant ovarian cancer

ROMA

Also read this: What to expect when expecting childbirth with 40+

ROMA> 24.7% = High risk of developing malignant ovarian cancer

ROMA

Also read this: Psychological aspects of pregnancy in adulthood

Determination of tumor markers is an indispensable part of the diagnostic treatment, course of treatment and monitoring of patients with various types of ovarian (ovarian) cancer.

Due to the need for a new, more reliable and specific tumor marker, the HE4 marker was developed. The fact that CA125 is not a satisfactory tumor marker for ovarian cancer, and the late diagnosis of this tumor, prompted the researchers to find a new biomarker for this tumor. Of all the potential biomarkers for ovarian cancer, the HE4 tumor marker gave the best results for clinical use.

Also read this: Birth preparation – release from fear

To date, HE4 has proven to be a particularly promising marker for early detection of ovarian cancer.

The new marker demonstrates its potential in differentiating women with ovarian tumors from those with benign (non-malignant) ovarian conditions.

Also read this: By practicing yoga until after childbirth

One of the advantages of the HE4 marker is that it can correctly identify benign lesions with respect to CA125. However, due to extreme heterogeneity and genetic abnormalities in ovarian cancer, there is a need to use multiple markers, of which HE4 and CA125 may be a component.

The combination of HE4 and CA125, with ROMA calculation, can separate patients at high and low risk of malignancy. The combination of these two markers enabled the detection of those cases not expressing CA125.

Also read this: Everything you need to know about postpartum depression

Studies show that among women who have had ovarian cancer confirmed, there were a significant number of women who were negative for the CA125 tumor marker.

At the same values, the tumor marker HE4 was positive, as expected. This means that the CA125 tumor marker is not a reliable marker for ovarian cancer and that the HE4 tumor marker gives better results.

Also read this: Get pregnant or not with 40+ ?!

For the early detection of ovarian cancer, the benefit of determining the value of the tumor marker CA125 from the blood and examination by transvaginal ultrasound (UZV).

However, none of these diagnostic procedures are routinely performed. CA125 marker because it is not sensitive enough and specific. This means that a false positive can be found in healthy women, that is, a false negative in women with cancer.

Also read this: How Chinese Traditional Medicine Can Help in Conception and Pregnancy

However, the movement of the CA-125 marker value is of exceptional benefit for monitoring treatment outcomes and early detection of disease return or progression in women who already have confirmed ovarian cancer.

Unfortunately, the only reliable method to determine with 100 percent certainty what to do with the ovaries is histopathological diagnosis, after considerable surgery.

Also read this: Ovarian Problems – Blocking Female Creative Force

For women who smoke and regularly take C and E vitamins, their risk of ovarian cancer is reduced by 12 percent.

There are few women who have not met with ovarian cysts, in most cases these are benign changes that usually occur just before or after menstruation.

Also read this: Vaginism – Dysfunction in Female Sexual Functioning

These are functional cysts, which most commonly occur. They occur mostly on one, rarely on both ovaries at the same time, are of different dimensions, and are known to be larger than 5 cm.

There are two basic types of cysts: follicular and luteal cysts.

Follicular are the consequence of lack of follicle rupture, that is, lack of ovulation.

Also read this: The truths and misconceptions about breast cancer

Luteal arose because the yellow body did not perish, and it would have to because it did not fertilize (cystic degeneration of the yellow body).

Classical gynecological examination does not determine which cysts are involved, so the findings are given according to the subjective feeling of the patient.

Ultrasound can be said more clearly and accurately, but not 100 percent.

Also read this: How to Prevent and Treat Cervical Cancer |

Follicular functional cyst is clear in content and smooth, has a thin wall, unlike lutein, which gives different images by ultrasound examination.

Luteal cysts are often known to be full of blood, which is caused by bleeding in them. These are hemorrhagic cysts (corpus luteum hemorrhagicum) and they are the ones that cause problems.

Also read this: Myths and prejudices about female orgasm

In the second phase of the cycle (after ovulation) they cause bloating, pain, a feeling of heaviness in the small pelvis. This usually lasts until the menstrual period itself, when cysts spontaneously withdraw due to changes in hormone levels. The woman should then avoid heavy exertion, sudden movements, intense exercise, and carrying loads.

All described can cause the cyst to burst or cause the ovary to turn suddenly, which is a dangerous condition that must be surgically resolved.

Benign non-functional cysts are produced by the exuberance of superficial, sexual or ovarian embryonic cells and are not related to hormonal activity.

Also read this: How to tighten your vaginal muscles

This includes a number of different cystic tumors.

Often, such cysts can be up to 10-15 cm in size and even larger. The contents of such cysts are often known to be slightly blurry (ultrasound) and to be more blurry, which is a characteristic image of endometriosis, and sometimes the contents appear very tight.

Also read this: Is your vagina as dry as a Sahara?

Such cysts rarely appear on both ovaries.

Diagnosis is made by gynecological examination, ultrasound, Doppler with assessment of blood flow resistance index and evaluation of tumor markers (CA 125, 15-3, CA 19-9, CEA, aAFP, B hcg).

Women begin to feel symptoms only when the cysts of their size change the anatomical relationships in the pelvis, causing pain during intercourse or a feeling of tension.

Also read this: Sex during menstruation is desirable

Thicker, endometrial cysts cause pain during the menstrual cycle, with irregular menstrual bleeding (brown tar secretion just before or after menstruation).

These cysts are treated only surgically.

Also read this: How To Prevent Leukorrhea – White Wash

The most important thing is to be examined by a doctor who will also operate you, if necessary, and which deals with this type of surgery. It is important to know that only about 10 percent of gynecologists in Serbia are engaged in this type of, so-called, major surgery, and they are mostly employed in tertiary hospitals.

In order to avoid any changes in the ovaries, it is necessary to control the ovaries as often as possible. There are two large state gynecological clinics in Belgrade that do this kind of surgery every day (GAK People's Front and GAK Višegradska). For example, u GAK Visegradska there is a great gynecological – oncology council, consisting of three gynecology professors, two oncology professors, a radio oncologist and a pathologist, who each individually review and decide on further treatment.

Also read this: Myths and prejudices about female orgasm

If you are from the inside, I advise you to always go for another opinion with another doctor. When you carefully choose a doctor, that one becomes the principal and responsible. Preferably this one does everything, diagnostics, pre-operative preparation, treatment, surgery and postoperative follow-up.

Also read this: Breastfeeding women – how to nurture them and preserve their health

It is very important that you should by no means allow one doctor, who does not have surgery, to accompany you to the doctor's office or the Health Center, the other prepares you for surgical treatment, the third receives you to a large clinic, only the fourth to operate you, and the fifth to follow you after surgery. In this way you will also avoid a whole host of unnecessary examinations and possible lapses in treatment.

Source: sitoireseto.com

Eng News 24h Everything You Need to Know About Ovarian Health: Ovarian Cancer, Cyst and ROMA Index

from WordPress https://ift.tt/2N7Jw8z via IFTTT

[drsadhanakala]

BREAST CANCER

Every woman is at risk of Breast cancer “The only person who can save you is you” – Sheryl Crow

SYNOPSIS

Breast cancer (BC) is the biggest killer-cancer of women in the world, and in India. In the next fifteen years, BC will kill over twelve lakh women in India. But it doesn’t have to. A few life style changes can reduce the incidence of BC; and early detection can increase the survival rate.

BC was a disease of old age. No longer. Twenty-five years ago, 69% of BC patients in India were age 50 and above. But now only 52% are 50 and above; 48% are less than 50; and a few are in the teens.

Every woman is at risk of BC. It cannot be prevented. The risk increases with age, heredity and genetic predisposition; and the risk reduces with healthy weight, regular exercise and healthy diet.

Early detection is the key to survival. Early detection can be by self-examination of breasts, or by screening by imaging devices such as X-ray, Ultra sound, and MRI. However, confirmation is only possible by biopsy.

Depending on the stage at which the cancer is detected, the treatment can be surgery, radiation, chemotherapy and other adjuvant therapies.

If detected early, BC is treatable. If detected late, it is fatal. Five-year survival rate for Stage 1 BC is 100%; for stage 4 is 22%.

So exercise and eat healthy and you would have done your bit to reduce your cancer risk. And do regular cancer screening and you would increase the probability of early detection and of successful treatment.

INTRODUCTION

Breast cancer (BC) will kill about 80,000 women in India in 2020. For every two women with BC, one will die. Many of these deaths are preventable simply by early detection. But detection is often late and thus fatal. Lack of awareness is the major reason for late detection.

Breast cancer is the most common cancer in women in India, 27% of all cancers, closely followed by cervical cancer at 22%. Incidence of and death due to BC is more than that due to cervical cancer. BC is rising at a rapid rate. By 2030, the number of BC cases will rise to about 200,000 a year and deaths to about 100,000 a year. India has the worst survival rate from BC, and the highest number of women dying from BC, in the world. Even if we start a cancer awareness program today, 20-30 years will pass before its effect becomes discernible.

BC was a disease of old age. Twenty-five years ago, 69% of BC patients were above the age of 50. Now 48% are below the age 50; and 20% of them below the age of 40.

Breast cancer cannot be prevented. But BC incidence can be reduced by a few simple lifestyle changes; and the survival rate can be improved by early detection.

WHAT IS CANCER ?

Our body is composed of many different types of cells. These cells grow and divide in a controlled manner to produce more cells as required by the body. Also, the older cells and the damaged cells die.

However, sometimes, the genetic material of one cell gets damaged or changed [mutation] and the cell becomes immortal: that is, it will not die. When this ancestor cell divides, its descendant cells are also immortal. This gives rise to a limitless number of immortal descendant cells. The number of cells is far in excess of what the body needs. The extra cells then form a mass that is called a tumour.

These immortal cells are called cancer cells. The cancer cells are: immortal; capable of limitless division, and thus of limitless growth in the number of cells; and capable of spreading [Metises] to other parts of the body through blood and lymph system.

There are more than 100 types of cancers. Not all cancers form tumours: cancers of the blood and the bone-marrow [leukaemia], for example, do not form tumours.

Most cancers are named for the body part in which they begin: colon cancer, prostate cancer, ovarian cancer, breast cancer and so on.

WHAT IS BREAST CANCER ?

Breast consists of lobules (milk producing glands), ducts (tiny tubes that carry the milk from lobules to the nipple) and blood and lymphatic vessels. Breast cancer is a malignant tumour that starts in the cells of the breast. It begins in the ducts; sometimes in the lobules; and rarely, in other cells of the breast.

It then spreads through the breast lymph vessels to lymph nodes under the arms and thence to other parts of the body.

WHO IS AT RISK OF BREAST CANCER ?

Every woman is at risk of breast cancer. In India, one in 28 women will get breast cancer. Certain factors increase the risk of BC.

AGE. Cancer is a disease of old age: most cancers begin to strike at age 60 and above. But now cancer is also striking, though only rarely as yet, the teenagers. Risk of breast cancer, for example, is about 0.25% for a 30-year old woman but increases to about 11% in a seventy-year old. In different countries, breast cancer risk in a 70-year old is 54% to 154% higher than in a 30-year old. Thus, as longevity has increased, so has the cancer incidence.

HEREDITARY. If first degree relatives [mother/father/brother/sister] had cancer, the risk of cancer is increased.

GENETICS. A person can be genetically predisposed to get cancer. A woman who has a family history of breast cancer is statistically more likely to get breast cancer. However, only a small percentage, less than 0.3% of population, is genetically disposed to get cancer. And less than 3-10% of all cancers are because of genetic predisposition. In women with BRCA 1 and BRCA 2, the probability of getting breast and ovarian cancer is more than 75%. Mutations in a few other genes [PTEN, CDH 1, TP 53 etc.] also increase the risk though not as much.

OBESITY. In obese postmenopausal women breast cancer risk is twice as much as in the non-obese women.

DIET. Diet contributes to up-to 80% of cancers of colon, prostate and breast; and also contributes to cancers of pancreas, lung, stomach and esophagus. Alcohol, red meat, sugar increase the risk of cancer.

SMOKING, night work, no children or child born after age 30, recent use of oral contraceptives (reverts to normal on stopping), HRT, and Chemicals in environment – increase the cancer risk.

MENOPAUSE. Late menopause increases the risk.

REDUCING THE RISK

Healthy weight, physical activity – brisk walking, cycling, swimming – 45-60 minutes five or more days a week, Breast feeding, no red meat, less sugar and less alcohol lowers the risk.

Controversy about whether diet rich in whole grains, fruits, vegetables and legumes and low in total fat (butter, oil), more vitamins, Marine Omega 3 fatty acids (found in seafood (e.g. fish oils) and in walnut, seeds, flaxseed oil etc.), and antiperspirants and bras reduce the risk. Abortion and Breast Implants have no effect.

Selective Estrogen Receptor Modulators such as tamofoxien reduce BC risk but increase the risk of thromboembolism and endometrial cancer. So eat well and exercise and you would have done your bit to reduce your cancer risk.

EARLY DETECTION

Since cancer-prevention is not possible, the saying, “prevention is the cure” is amended to “early detection is the cure.”

Only about 10% of cancer deaths are because of primary tumour. Most of the deaths are because of metastasis – spreading of the cancer to other parts of the body. Once metastasis happens, it is very difficult to treat. Early detection of cancer is therefore of utmost importance.

Several ways of early detection:

1. SELF-EXAMINATION OF BREASTS More than 80% cancers are detected by women doing self-examination of breasts. The examination should be done every month, 5-7 days after menorrhoea. Do the examination as shown in the three pictures. Look for the following:

• Lumps in breast (less than 20% are cancer) or in lymph nodes in armpits. • Thickening of breasts • One breast becoming larger than other • A nipple changing position or shape or becoming inverted • Discharge from nipple • Constant pain in part of breast or armpit • Swelling beneath the armpit or around the collarbone

In case of palpated anomaly, consult your gynecologist.

The limitations of self-examination are:

• Only 20% women do self-examination of breasts. • The tumour/changes are large by the time they are felt and this delay in detection can adversely affect the treatment outcome.

2. IMAGING TECHNIQUES Early detection of cancer is required and is possible by using Imaging Techniques. Six Imaging Techniques are available:

• X-ray (Mammography) • Ultra sound (Sonography) • MRI • Computer Assisted Detection (CAD) • CT-scan • PET

A visual inspection by endoscopy can also be done.

• MAMMOGRAPHY. X-rays examination. Small neoplasmatic tissue formations can be seen. • SONOGRAPHY Sonography is done in addition to Mammography to rule out possible cysts and to estimate the size of the tumour. However, tumours smaller than 5 mm cannot be detected. • MRI MRI is used to find out if the breast has been affected by more than one tumour. • COMPUTER ASSISTED DETECTION (CAD) CAD is used to point out possibly diseased regions. It is used mainly as a second opinion to the report of the doctor.

LIMITATIONS OF IMAGING

• Imaging techniques magnify the tumour much as the magnifying glass magnifies the letters in a book. Normal letter size, called font, is 12. If the font size is halved, that is made 6, you may still be able to identify the letter. But if the font is reduced still further, say to 3 or 4, you will not be able to identify the letter even with the magnifying glass. In a similar way, the imaging techniques cannot identify tumours that are small. • The QUALITY of cancer is more important than the QUANTITY. A small tumour can be more dangerous than a large tumour. Imaging can tell the quantity of the tumour, that is, its size, but cannot tell the quality of the tumour.

• Most of the time, Imaging cannot even tell whether a tumour is cancerous or not.

CONFIRMING CANCER

The only absolute way to confirm cancer is by biopsy: a small tissue from the tumour is taken and microscopically examined to check for cancer.

TYPES OF BIOPSY

• Punching Biopsy. Done in a locally-sedated state. • Needle Biopsy. Done with a syringe and a special needle. As painful as venepuncture. • Advanced Breast Biopsy Instrumentation (ABBI). Done with X-ray to ensure localisation of target. Only a few doctors are experienced in this technique.

Microscopic examination of biopsy is sufficient; but in a few rare cases specialized lab tests are required.

CANCER TREATMENT

Even small localised tumours have the potential of metastasis and therefore need to be treated. The treatment is surgery, medications (hormonal therapy and chemotherapy), radiation and immunotherapy.

Surgery offers the single largest benefit. Used along with chemotherapy and radiation, the local relapse rate is reduced and the overall survival rate may increase.

SURGERY • Mastectomy: remove whole breast. • 2Quadrantectomy: remove quarter breast. • 3Lumpectomy: remove small part of breast. • Breast Reconstruction Surgery or breast prostheses: to simulate breast.

Neo-adjuvant, that is prior to surgery, and Adjuvant that is after and in addition to surgery, medication is used as part of treatment. For example, Neo-adjuvant use of aspirin may reduce the mortality from Breast Cancer.

Adjuvant Therapies are:

Radiation (negative effect on normal cells) to kill cancer cells in tumour bed and regional lymph nodes that may have escaped surgery. It reduces the risk by 50 – 66 % (i.e., 1/2 to 2/3 reduction of risk). It is confined to region being treated. But only solid tumour can be treated.

Therapies using drugs/agents etc.

• Chemotherapy (negative effect on normal cells). Uses drugs, usually two or more drugs in combination, to destroy cancer cells. • Targeted Therapy that became available in 1990s that uses drugs that inhibit enzymes. • Monoclonal Antibody Therapy in which the agent is an antibody • Immunotherapy that uses patient’s immune systems to fight cancer using drugs. • Hormone Blocking Therapy. Uses Estrogen Receptors (ER +) Tamoxifen and Progesterone Receptors (PR +) Anastrozole that block the receptors.

Experimental Cancer Treatment 1. Gene Therapy 2. Ultrasound Energy.

Alternative Medicine.

Patients with good prognosis are offered less invasive treatment – e.g. lumpectomy + radiation + hormone. Patients with poor prognosis are offered more aggressive treatment – extensive mastectomy + radiation + chemotherapy + adjuvant medication.

TREATMENT SUCCESS RATE

If the cancer is detected early, that is at Stage 1, prognosis is excellent and usually chemotherapy is not required.

If detected in Stage 2 & 3 prognosis is progressively poorer with a greater risk of recurrence. Surgery, chemotherapy, and radiation are required.

If detected in Stage 4, that is metastatic cancer (spread to distant sites), prognosis is poor. Surgery, radiation, chemotherapy, and targeted therapies are used. But the 10-year survival rate is 5% without treatment and 10 % with optimal treatment.

In India, more than 60% of the BC’s are diagnosed at stage III or IV. Hence the low survival rate.

For Consultation with Best Gynecologist in Delhi contact us : +91-9999886583, +91-9999889464

PSYCHOLOGICAL AND EMOTIONAL ASPECTS

Cancer patients need psychological and emotional support. Besides the family, such support can be provided by support groups who are trained and experienced in providing such support. ‘Cancer Sahyog’ is one such support group in India.

CONCLUSION

Cancer is a 3200 year old disease. It is endogenous, a part of life-process. So it can neither be eradicated, nor prevented, nor cured.

As yet.

Over the past 2000 years, the survival rate for many cancers has improved dramatically: life expectancy increased by 20-30 years. But for a few other cancers – metastatic pancreas cancer, metastatic breast cancer, in-operable gallbladder cancer – improvement has been marginal: life extended by just a few months.

Late detection of cancer is fatal. The causes for late detection are many but lack of awareness is the principal cause. Other main causes are: patient being shy, social stigma and doctors’ ignorance because of which the treatment is delayed. An awareness program with Best Gynecologist in Delhi will address all these issues.

Present state of our knowledge makes us believe that cancer prevention or cure is not possible because cancer is a product of the processes essential to the life process.

Will some radical discovery in the future make cancer prevention and cure possible? We don’t know. But we can always hope.

Because as Richard Clauser, Director, National Cancer Institute, USA, says about the future of cancer cure, “There are far more good historians than there are prophets.”

REFERENCES

1. India still has a low breast cancer survival rate of 66%: study: For every 2 women newly diagnosed with breast cancer, one woman dies of it in India https://www.livemint.com/Science/UaNco9nvoxQtxjneDS4LoO/India-still-has-a-low-breast-cancer-survival-rate-of-66-st.html 2. Epidemiology of breast cancer in Indian women: Breast cancer epidemiology: https://www.researchgate.net/publication/313545712_Epidemiology_of_breast_cancer_in_Indian_women_Breast_cancer_epidemiology 3. Epidemiology of breast cancer in Indian women https://www.ncbi.nlm.nih.gov/pubmed/28181405 4. BREAST CANCER INDIA Correct information is .. half the war won already http://www.breastcancerindia.net/statistics/trends.html 5. Breast Cancer Survival Rates https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html 6. The Top 5 Cancers Affecting Women Top 5 Cancers Affecting Women https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx 7. The Emperor of All Maladies: A Biography of Cancer – a book by Siddhartha Mukherjee, a physician and oncologist. Available at Amazon and at Flipcart