Lung Cancer Awareness

What causes Cancer Cervix?

The causative factor for cervical cancer is a virus called Human Papilloma Virus (HPV), which causes over 99% cases of cervical cancer. This virus is transmitted through sexual contact. There are over 90 types of HPV viruses which have been identified. These are categorized into Low risk /high risk depending on there ability to cause cervical cancer. Women with persistent infection with High risk types are likely to develop cervical cancer

What are risk factors for developing cervical cancer?

Sexual intercourse at an early age, multiple sexual partners, multiple childbirth, smoking and weakened immune system are known risk factors associated with the development of cervical cancer.

Is it preventable?

Cervical cancer is definitely preventable, as there is an effective screening test available to detect precancerous changes which can be treated and progression to cancer can be stopped.

What is screening?

Screening is looking for cancer before you have symptoms. It is a test which helps us to diagnose the precancerous changes or cancer early and hence the disease can be treated more effectively.

What are the screening tests available for cervical cancer?

Worldwide cervical cytology (Pap smear) is used as a screening test for cervical cancer.

Current evidence also points effectiveness of HPV- DNA testing as a screening test for cervical cancer.

What is a Pap smear test?

It is a simple outpatient procedure in which cells will be collected from the cervical surface by scrapping and will then be evaluated by Pathologist to see if abnormal cells are present. Depending on the result further evaluation is planned.

When should I get myself tested?

As per international recommendations, one should start getting regular Pap tests at age 21, or within three years of the first time you have sex, which ever happens first. The Pap test is one of the most reliable and effective cancer screening tests available.

It is vital for women over 30 yrs to be part of the screening programme. The screening initially is done at yearly interval and after three negative smears the interval can be increased. It is also important to follow-up results of the test, after you have done a Pap smear

What are the signs and symptoms of cervical cancer?

Following are some of the symptoms of cervical cancer: –

• Abnormal bleeding-.
• Unusual heavy discharge-
• Pelvic pain
• Pain during urination-
• Bleeding between regular menstrual periods, after sexual intercourse or douching.

An anxious 29 yrs old lady walked in my clinic with her husband and family members. She was recently diagnosed with cervical cancer and was advised surgery, which would essentially render her infertile (As conventional surgery for cervical cancer requires complete removal of uterus). As she was childless was very keen to know if, any surgical option is available, which can preserve her fertility. Fertility preservation surgery (Radical Trachelectomy) is an accepted treatment for cervical cancer, but there are strict criteria to identify eligible patients.

After counseling and examination, we started evaluating this patient to identify, if she was a suitable candidate for fertility preserving surgery, which included MRI to note the extent of size and spread. After completion of all necessary tests, she was identified as a suitable patient for radical trachelectomy.

Radical trachelectomy is a surgery in which only the diseased cervix along with lymph nodes are removed, leaving behind the upper part of the uterus which is then sutured with vagina. Also whenever possible this should be done by a minimally invasive (Keyhole) approach, so the handling of tissues during surgery is less and hence problems for future conception are avoided. The Robotic assisted surgery works best in this situation as the suturing of the uterus with vagina can be extremely difficult and the endowrist instruments with magnified 3D vision makes this part of the procedure as well as the dissection extremely safe and effective. At Kokilaben Dhirubhai Ambani Hospital,

We discussed and counseled the patient and her husband about the surgery and the advantages of using Robotic platform. She underwent Robotic Radical trachelectomy with bilateral pelvic lymph node dissection at Kokilaben Dhirubhai Ambani Hospital and Research center .. Her postoperative recovery was uneventful and was discharged from the hospital on 5th Postoperative day. She will be closely observed for a period of 1 year and then if things are fine she can attempt pregnancy.

Cervical cancer is the most common Genital tract cancer seen in Indian women with an incidence on 22.9/100000 women. Every year over 122000 new cases are diagnosed in India and almost 67000 women die every year because of this disease. Radical trachelectomy is an established surgery for early stage cervical cancer for women who desire future fertility.

Unfortunately in India, women do not present early hence there are not many patients who can undergo this operation. This was second such case operated at our hospital. The first case was a 4-year-old girl diagnosed with cervical cancer. Robotic assisted surgical platform is of great help in performing these surgeries as, the technology allows you to overcome some of the problems you face when you do these complex surgeries and also help patient recover fast postoperatively.

In the end it was great to see smile back on her face, not only relieved of all the stress and anxiety regarding her cancer treatment, but also being able to preserve her ability of being a mother.

Dr Yogesh Kulkarni,
Consultant, Gyn Oncology & Robotic Surgeon
Kokilaben Dhirubhai Ambani Hospital. Mumbai
M: 93215427311

Mail. Yogesh.v.kulkarni@relianceada.com

What is Cancer?

Cancer is a broad term. It describes the disease that results when cellular changes cause the uncontrolled growth and division of cells. Some types of cancer cause rapid cell growth, while others cause cells to grow and divide at a slower rate. Certain forms of cancer result in visible growths called tumours, while others, such as leukaemia, do not.

Cancer statistics in India

• One woman dies of cervical cancer every 8 minutes in India.
• For every 2 women newly diagnosed with breast cancer, one woman dies of it in India.
• Mortality due to tobacco use in India is estimated above 3500 persons every day.
• Tobacco (smoked and smokeless) use accounted for 3,17,928 deaths (approx) in men and women in 2018.
• Cancer took 7 lakh lives in India in 2018.
• India has around 22.5 lakh people living with cancer.
• Every year, more than 11 lakh new cancer patients are registered in India.

Cancer Symptoms

Signs and symptoms caused by cancer will vary depending on what part of the body is affected. Some general signs and symptoms associated with, but not specific to, cancer, include:

• Lump or area of thickening that can be felt under the skin.
• Weight changes, including unintended loss or gain.
• Skin changes, such as darkening or redness of the skin, sores that won’t heal, or changes to existing moles.
• Difficulty swallowing.
• Persistent indigestion or discomfort after eating.
• Persistent, unexplained muscle or joint pain.
• Unexplained bleeding or bruising.

What causes cancer

Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal function and may allow a cell to become cancerous.

What do gene mutations do?

A gene mutation can instruct a healthy cell to:

• Allow rapid growth. A gene mutation can tell a cell to grow and divide more rapidly. This creates many new cells that all have that same mutation.
• Fail to stop uncontrolled cell growth. Normal cells know when to stop growing so that you have just the right number of each type of cell. Cancer cells lose the controls (tumor suppressor genes) that tell them when to stop growing. A mutation in a tumor suppressor gene allows cancer cells to continue growing and accumulating.
• Make mistakes when repairing DNA errors. DNA repair genes look for errors in a cell’s DNA and make corrections. A mutation in a DNA repair gene may mean that other errors aren’t corrected, leading cells to become cancerous.

These mutations are the most common ones found in cancer. But many other gene mutations can contribute to causing cancer. 5 to 10% gene mutations are due to genetic reasons. Others are caused due to smoking, radiation, viruses, cancer-causing chemicals (carcinogens), obesity, hormones, chronic inflammation and a lack of exercise.

Prevent Cancer

Here are a few steps to take in daily life to prevent cancer.

1. Say No to Tobacco – The use of tobacco products has been linked to many types of cancer, including lung, colorectal, breast, throat, cervical, bladder, mouth and oesophageal. It’s never too late to quit.

2. Protect your skin from sun – Skin cancer is the most preventable form of cancer. Exposure to the sun’s ultraviolet radiation causes most skin cancer. Be sure to use adequate sun protection year-round.

3. Eat a healthy diet – Eat lots of fruits, vegetables, beans and whole grains. Limit red meat and cut out processed meats. It is also important to limit alcohol consumption because alcohol can increase your risk for liver, colorectal and breast cancers.

4. Maintain a healthy weight and be physically active – Getting at least 30 minutes of physical activity each day can make a big difference in your general health and well-being. Inactivity and obesity have been linked to breast and colorectal cancer.

5. Practise safe sex – Many strains of the human papillomavirus, also known as HPV, are spread through skin to skin contact during vaginal, anal and oral sex. High-risk strains of HPV have increasingly been found to cause many types of cancer.

6. Get immunized – Certain viruses have been linked to cancer, but are preventable through vaccination. Talk to your doctor about preventive cancer care.

7. Be regular with cancer screenings – Talk to your family doctor to know more cancer screening tests. Early detection highly increases your chances of recovery.

Cancer treatment

Below are examples of approaches to cancer treatment:

• Chemotherapy aims to kill cancerous cells with medications that target rapidly dividing cells. The drugs can also help shrink tumors, but the side effects can be severe.
• Hormone therapy involves taking medications that change how certain hormones work or interfere with the body’s ability to produce them.
• Immunotherapy uses medications and other treatments to boost the immune system and encourage them to fight cancerous cells.
• Radiation therapy uses high-dose radiation to kill cancerous cells. Also, a doctor may recommend using radiation to shrink a tumor before surgery or reduce tumor-related symptoms.
• Stem cell transplant can be especially beneficial for people with blood-related cancers, such as leukemia or lymphoma. It involves removing cells, such as red or white blood cells, that chemotherapy or radiation has destroyed. Lab technicians then strengthen the cells and put them back into the body.
• Surgery is often a part of a treatment plan when a person has a cancerous tumor. Also, a surgeon may remove lymph nodes to reduce or prevent the disease’s spread.
• Targeted therapies perform functions within cancerous cells to prevent them from multiplying. They can also boost the immune system. Two examples of these therapies are small-molecule drugs and monoclonal antibodies.

Doctors will often employ more than one type of treatment to maximize effectiveness.

Cancer care at Kokilaben Dhirubhai Ambani Hospital:

Our Centre for Cancer is equipped with high-end technologies like:

• EDGE Radiosurgery system, Asia’s first equipment which enables precise, non-invasive treatments helping patients heal faster with less discomfort.
• We are the first hospital in India to have Novalis TX machine, which performs high precision surgeries to remove deep-seated tumours.
• We have the first Trilogy (linear accelerator) in India, which is capable of performing on-board CT scan, KV and MV imaging with respiratory gating systems.

Cancer Care in rural Maharashtra:

• Our team has started Cancer care centres across Maharashtra under Reliance Hospitals. We plan to establish 18 cancer care centres across Maharashtra. The centres will be managed and operated by Kokilaben Dhirubhai Ambani Hospital. The new cancer centres will be equipped with advanced TrueBeam® medical linear accelerators to equip them with the latest technology. The Akola, Gondia and Solapur Reliance Cancer centres are now open and the rest will follow in a few years. We aim to make world-class cancer care accessible to all Indians.

Please find below link of our Cancer care facilities in Mumbai, Navi Mumbai and in rural Maharashtra:

https://www.kokilabenhospital.com/departments/centresofexcellence/technology/centrefor_cancer.html

https://www.reliancehospitals.com/