Gynecology : Dr Sumitha Nandan Answers

Health queries sorted out here…
Dr. Sumitha Nandan of MAcare ( Manappuram Health Care), Valapad answers…

Are there things that can be done to minimize the risk of cancer?

First and foremost thing is to understand the risk factors of cancer, the symptoms associated with them and early detection of the cancer. Any cancer which is detected early has a better survival rate.

The most common cancers which are encountered among the Indian women are the Cancer Cervix, Ovary, Breast and Endometrium(Inner lining of the uterus).

For any cancer there are risk factors like the genetic predisposition, lifestyle, exposure to caricinogenic (cancer causing) substances etc..

The risk factors for cancer cervix are Human Papilloma Virus infection, early sexual intercourse (</= 16 years), low socio-economic status, multiple sexual partners, sexually transmitted diseases like Herpes Simplex virus infections, chlamydial infections, HIV infections etc. In case of cancer cervix the duration between the appearance of precancerous condition and culmination into full blown cancer cervix is long hence the detection rates and survival rates are higher if screening tests are undertaken early. The screening tests for cancer cervix are the pap test, colposcopy, HPV DNA testing,

In case of ovarian cancer, the most common is the epithelial ovarian cancer which occurs in elderly women (peak age of 55-60 years). About 30% of ovarian tumours detected in the postmenopausal women are malignant. Ovarian cancers has a genetic predisposition which means it runs in families.  Ovarian cancer has been associated with low parity and infertility. Having atleast one child gives protection of upto 30-40% and also use of oral contraceptive pills. Incase of symptoms like lump in the lower abdomen which is growing in size, heaviness or dull aching pain in the lower abdomen, abnormal bleeding patterns, bleeding after menopause, or GI symptoms like nausea, indigestion,constipation a gynaecologist should be consulted for a pelvic examination and/or ultrasound.

Early detection of breast cancer is improved by risk assessment, clinical breast examination and screening mammography. The risk factors for cancer breast is increasing age(appproximately 50% occur after 65years of age), age of menarche less than 12years, having no children, late menopause,family history of breast cancer especially among the first degree relatives, hormone therapy, previous history of breast cancer or any breast biopsies showing atypia. The symptoms of Cancer Breast are usually nipple discharge (especially bloody discharge), lump in the breast, breast pain, changes in the size, shape and texture of the breast, irregularity in the menses. Those women at risk should undergo mammography atleast at the age of 40 years as mammography can detect slow growing breast cancers atleast 2 years before the mass can be felt by the hand. Self Breast Examination should be done atleast every 6 months who do not belong to the high risk category and incase of any suspicious lump or discharge should be brought to your consultants notice at the earliest and mammography done if desired.

Endometrial cancers are those which are detected early and treated early as their symptoms are usually alarming like profuse and/or prolonged menses, bleeding in between menstrual cycles, postmenopausal bleeding. This cancer is oestrogen dependent and the women at risk are those who attain early menarche and late menopause, diabetics, obese, hypertensive, with polycystic ovarian syndrome, family history of cancers like endometrial, breast ,ovarian or colon cancer , those who have not given birth and on hormone therapy with tamoxifen. In case of any above mentioned symptoms, your gynaecologists should be consulted and endometrial biopsy should be done which needs to be histopathologically examined.

How often should the mammograms be done?

The age and the number of times the mammogram screening depends on the risk category a person belongs to. As per the guidelines, a woman of average risk for breast cancer should begin mammographic screening at age 40. For women between 20s-30s, a clinical breast examination is suggested at least every 3 years, and preferably annually, as part of a well- woman examination. For women older than age 40, annual clinical breast examination and mammography are recommended. For older women, recommendations for mammographic screening may be individualized based on the presence of any co-morbid conditions. For high risk women, consideration can be given to screen earlier (5-10 years earlier than the age of the average risk women) and shorter intervals between screening.

 Can an ovarian cyst be normal?

The risk of ovarian cyst being benign or malignant depends on the risk factors of a woman, symptoms and signs a woman present with, and then the size of the cyst, contents of the cysts, thickness of the septums within the cyst and also the vasularity.

How can endometriosis affect the fertility?

There are numerous mechanisms by which endometriosis can affect fertility. When endometriosis is moderate or severe, involving the ovaries and causing adhesions it block tubo-ovarian motility and ovum pickup leading to subfertility.

What is premature ovarian failure?
Usually menopause (permanent cessation of menstruation) occurs at a mean age of 51 years. Premature ovarian failure,is when menopause occurs before the age of 40 years.

Dr. Sumitha Nandan Jayasankar, MBBS, MS(OBG),
MAcare ( Manappuram Health Care), Valapad