Saswati Sarkar
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Written By: Saswati Sarkar | Published : February 4, 2019 10:10 PM IST
New drug may benefit women with advanced ovarian cancer stage.©Shutterstock
Indian data on cancer has been showing a rather surprising trend of late: More women are affected by cancer than men in our country. The global cancer trend, however, is just the opposite. Currently, breast and ovarian cancers are among the most common forms of cancer in India. This trend calls for a closer look at gynaecological cancers. In this exclusive interview, Dr. Rama Joshi, Director & HOD, Gynae Oncology and Robotic Surgery, Fortis Memorial Research Institute, Gurugram, talks about various types of cancer that affect your reproductive organs.
Q. Apart from ovarian cancer, cervical and uterine cancer, what are the other forms of gynaecological cancers?
A. Cancer arising in the reproductive organs are known as gynaecological cancers. Vulvar and vaginal cancers are the other types of gynaecological cancers in addition to in addition to cervical, uterine and ovarian cancers. Gestational trophoblastic neoplasia (GTN), though rare, is another type of cancer arising out of a woman's reproductive organ during pregnancy. GTN is an umbrella term for gestational trophoblastic diseases, a rare group of tumors containing trophoblast cells. They originate in the uterus and are mostly related to pregnancy. They can be cancerous, but in most cases they re not.
Q. Who are mostly at risk for gynaecological cancers?
A. Risk factors vary with the type of cancer. Early onset of sexual activity, multiple pregnancies, multiple sexual partners of either or both the partners, persistent Human papillomavirus (HPV) that causes tumours, smoking, and HIV are the risk factors for cervical cancer. Obesity, early menarche and delayed menopause, infertility, anovulatory cycles (menstrual cycles with varying degrees of menstrual intervals and the absence of important phases), genetic factors and prolonged hormone replacement therapy (HRT) are the risk factors for uterine, ovarian and breast cancers. Persistent HPV infection that lead to tumours is the risk factor for both vulvar and vaginal cancers.
Q. Breast cancer or ovarian cancer, what is more prevalent in India?
A. Among these, breast cancer is more prevalent in India.
Q. Ovarian cancer or cervical cancer, what is more prevalent in India?
A. Among these two cancers, cervical cancer is more prevalent in India.
Q. Can endometriosis lead to ovarian cancer?
A. Yes, it can. In comparison to the general population, the incidence of ovarian cancer is almost double in patients with endometriosis.
Q. What is the link between breast cancer and ovarian cancer?
A. The risk factors of both these cancers are similar as mentioned earlier. Mutations of BRCA 1 and BRCA 2 genes have reported an incidence of 60-80 per cent breast cancer and the figure for ovarian cancer is 30-40 per cent.
Q. What are the most effective screening tests for ovarian cancer?
A. Screening for ovarian cancer is usually done for the high risk group, not the general population. However, no single test is effective. Transvaginal ultrasound with coloured doppler and tutor marker CA 25 are the usual screening tests.
Q. Does HRT increase the risk of ovarian cancer? How?
A. Yes, HRT increases the risk of ovarian cancer. Some on HRT is exposed to oestrogen for a prolonged period of time. That increases the risk.
Q. Does the use of talcum powder increase one's risk of ovarian cancer?
A. Increased incidence of ovarian cancer has been correlated with the use of talcum powder but there is no sure-fire evidence to suggest the same.
Q. Can ovarian cysts lead to ovarian cancer?
A. Ovarian cysts are of two types, simple and complex. The complex ovarian cyst is associated with malignancy. It is not related to your menstrual cycle and is rare.
Q. What are the screening tests for cervical cancer? How often should a woman be screened for it?
A. Pap Test and HPV DNA testing are the screening tests for cervical cancer. HPV DNA testing can be done after 30 years of age. Pap Test should begin at the age of 21 if a woman is sexually active for at least two years. This screening should be done at an interval of 3 years in the age bracket of 21-30 years while it should be accompanied by HPV DNA in women above 30 years of age. HPV DNA testing is recommended every 5 years. Women In high risk group may be screened at a shorter interval.
Q. Can patients treated for cervical or ovarian cancer expect to conceive?
A. Fertility preserving surgery of the cervix, the upper part of the vagina and surrounding supporting tissues are done in selected young patients at the early stage of cervical cancer. But then, chances of abortion in their second trimester are high. Elective caesarean section is performed in these cases. Patients are regularly followed up during pregnancy and following the caesarean section by the gynaec oncologist. In case of ovarian cancer patients also, fertility preserving surgery is done in cases where only one ovary is affected and the cancer hasn't spread anywhere else. One might need completion surgery after the child bearing .
Q. How prevalent is uterine cancer? What causes this condition?
A. It is the most common gynaecological cancer of the West and the third most common among this type of cancer in India. As reflected in all population-based cancer registries, the incidence of uterine cancer is increasing in India. The risk factors include obesity, anovulatory cycles, delayed menopause, HRT.
Q.Is robotic surgery widely used for the treatment of cancer in our country? How does it improve the treatment modality?
A. Currently, there are limited centres using robotic surgery in the country. Robotic surgery offers minimal access, more precision, minimum blood loss, quick recovery lesser complications, so on and so forth. Robotic technology is a boon, especially for obese, morbidly obese, and diabetic patients. It provides good perioperative as well as oncological outcomes in comparison to laparoscopy.
Q.What have been the major breakthroughs in the treatment of gynaecological cancer in the last 5 years?
A. Introduction of a diagnostic procedure known as sentinel node mapping in uterine and cervical cancer, Olaparib, a targeted therapy for ovarian cancer and HIPEC, a chemotherapy for advanced ovarian cancer are the major breakthroughs in this field.
