CANCERS AFFECTING MOTHERS, SISTERS, DAUGHTERS, AND WIVES | By Prof. Humera Mahmood

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BREAST CANCER AND GYNECOLOGICAL CANCERS TOGETHER CONSTITUTE MORE THAN 60% OF FEMALE CANCERS

Prof. Humera Mahmood
Head of Oncology & Radiology Departments
Atomic Energy Cancer Hospital

According to PAEC and NORI cancer registries, Breast cancer and gynaecological cancers together constitute about 60% of all female cancers.

Breast cancer alone is responsible for more than 40% of all female malignancies. All these cancers are mainly affecting our female population who as mothers, wives, sisters, and daughters play central roles in their families.

Although Breast cancer is being talked about a lot. Breast cancer awareness campaign is being run at different levels and more of our women are now presenting in early-stage disease yet still we are far to go.

In Pakistan common cancers are those of breast, colon, rectum, esophagus, oral cavity, throat, liver, uterus, cervix, ovary, prostate and lung.

The number of cancer patients in Pakistan is rising with each passing year. Work on national cancer registry has also been started and soon we will be able to know the prevalent risk factors in Pakistan and devise national strategy to overcome these factors.

Gynecological cancers are the second commonest cancers after breast cancer in our female population.

Gynecological cancers are being neglected or ignored. Cervical cancer like breast cancer is one of the preventable cancers and can be detected early by screening.

Unfortunately, more than 60% of our patients with cancers in general and gynecological and breast cancers in particular, present in locally advanced and metastatic stages that are incurable most of the time.

Hence we need to create awareness about gynaecological cancers as well so as to help in prevention and early detection.

Once cancer particularly gynaecological ca is stage III or IV, the patient’s condition is miserable. Although disease is still treatable, but the chances of cure are minimized.
Role of HPV in causing cervical cancer is very well established and HPV vaccine is being used at national level in countries with high risk of cervical cancer. This has not yet been possible in Pakistan.But we need to establish the prevalence of HPV in our patients.

At NORI one of our studies related to HPV positivity in normal women is already published. Another one is going on to establish the association of Human Papilloma Virus (HPV) with cervical cancer in patients presenting at NORI. Till now more than 60% of our cervical cancer patients have been found to be positive for HPV.

It’s high time to recommend the authorities for HPV vaccine to be included in National EPI program.

Being Muslims, this is our belief “Allah has not created any disease for which he has not sent cure.” Unfortunately, because of lack of awareness, religious and cultural beliefs and social taboos, people take cancer as death sentence. As a matter of fact, “Cancer” is a word not a sentence.

It is a common observation that when a person is diagnosed with cancer, not only the patient himself but all his relatives and friends lose hope and think as if this is the end of life. Just like any other disease cancer can not only be treated but can also be cured if detected at an early stage and timely and proper treatment is provided to the patient.

At the same time one third of cancers can be prevented by modification of lifestyle and dietary habits.  Prevention is always better than cure as it is less costly, and less time and effort is required for avoiding harmful factors.

Moreover, unlike road traffic accidents, heart attacks, suicidal attacks, cancer doesn’t lead to sudden death. It is more like a chronic disease   which needs to be taken care of throughout life once it is diagnosed just like diabetes, hypertension, arthritis etc.

To create cancer awareness, to remove myths and misconceptions about the disease and to show solidarity with all those who have suffered from the disease, Pakistan Atomic Energy Commission through its 19 dedicated cancer hospitals in Pakistan is committed to play its part in cancer control in the country not only by providing state of the art treatment and diagnostic facilities for cancer but also playing active role in cancer awareness and screening.

Atomic Energy Cancer Hospital NORI situated in the heart of Islamabad and working under Pakistan Atomic Energy Commission is providing cancer screening services and holding cancer awareness activities since its inception.

For the last 17 years its cancer awareness campaign has become much more organized and different activities are arranged throughout the year to stress on early detection, prevention and timely treatment of cancer. The whole month of October is dedicated for breast cancer awareness.

Oncology department of NORI has prepared education material about breast and cervical cancers and all other cancers for creating cancer awareness in public.

Awareness programs are mainly aimed at early detection and timely treatment of cancer. So we need to know the ways by which cancer can be detected at early stage and how and where it can be treated. For prevention of cancer we need to stress on the risk factors and how to avoid them.

In most of the cases it is not possible to ascertain the exact cause that led to the development of cancer but there are certain well known factors the excess or presence of which increases the risk of this menace.

Increasing age and genetic predisposition are unavoidable risk factors and they are complemented with avoidable factors. Cancer doesn’t follow any boundaries of age, race, cast, colour or creed. This can affect any age group, no matter rich or poor. Although the prevalence of certain risk factors in different geographical areas increases the susceptibility to different types of cancers.

This disease can be inherited. This point needs to be emphasized that it’s not always the mother who is to be blamed for the transmission of disease, but father’s family is equally responsible. If any type of cancer is present in any family member; paternal or maternal, the risk of developing cancer increases in rest of the family members.

The risk is much higher when first degree relatives are affected. Consanguineous marriages are also responsible for the transmission of cancer-causing genes in children. In addition to consanguineous marriages other avoidable risk factors are cigarette smoking, tobacco consumption, addiction of betel nuts and leaves, gutka, niswar, alcohol intake, sedentary lifestyle, obesity, low intake of fresh fruits and vegetables and taking more of red meat and fatty foods including fast foods.

Cancer cervix can be caused by immunodeficiency diseases including AIDS, multiple sexual partners, smoking etc.

Primary prevention of cancer is possible by avoiding risk factors. Smoking alone is responsible for one third of cancers.

So, it needs to be avoided. Parents should keep an eye on their children and should set examples for them by not smoking or quitting it. Passive smoking is as injurious to health as is active smoking. Avoiding smoking in public places can make a difference. Daily morning walks or mild to moderate physical activity can significantly reduce the risk of cancer.

It is said that two third of dining plate should be filled with fresh fruits, vegetables and grains. Healthy weight, healthy lifestyle, balanced diet, physical activity not only give protection against heart diseases but also help in preventing cancer and combating it even after the diagnosis. Professionals exposed to wood dust, fumes, dyes, paints and asbestos should use protective gadgets.

Viral infections including Human papilloma virus, Epstein Barr virus, Hepatitis B & C viruses and AIDS virus are responsible for a number of cancers. Protective vaccines should be provided under some national program and exposure to these viruses should be avoided by healthy habits. The incidence of Liver Cancer in Pakistan is rising rapidly and more than 90% of the cases are because of Hepatitis C.

Secondary prevention of cancer is detecting cancer at a very early stage with the help of screening which involves certain tests and examination. There are standard guidelines for screening of cancers of breast, cervix, colon, rectum and prostate. Although the number of women coming for screening of breast cancer has remarkably improved in Pakistan in the last 15 years yet still a lot needs to be done for other cancers. Strong national program for cancer screening is the need of the hour.

Another tool for early detection of cancer is to be able to identify early signs and symptoms of cancer. One should be health conscious and as some change is noticed in the body or there are signs that are not being relieved inspite of treatment, specialist doctor consultation should be sought. There are seven early warning signs of cancer.

These include the presence of lump or swelling, non-healing ulcer, persistent cough, bleeding from any site, unexplained loss of appetite and weight, change in the shape, size, colour of a mole or wart and change in bowel habits. Fortunately, all the lumps or swellings are not cancerous but one cannot decide oneself. Only an expert Oncologist or Surgeon can help in the diagnosis by examination and certain investigations.

The most common test which helps in the diagnosis of cancer is biopsy which involves taking sample of the tumour with the help of needle and studying it under microscope. A number of other investigations are also required to look for the spread of the disease.

The patients and their relatives get exhausted with investigations and insist on starting treatment without mandatory tests. Cancer can affect any part of the body from head to toe and its treatment is done according to age of the patient, type of cancer, stage of the disease and general condition of the patient. Each individual patient is different, and treatment needs to be individualized after discussion in multidisciplinary tumour boards which are routine at NORI hospital.

Cancer is divided into 4 stages. Contrary to developed countries, in Pakistan most of the cancer patients present in stages III and IV because of lack of awareness, denial, poverty, social and cultural taboos, lack of screening programs and non-availability of proper facilities in rural areas. Moreover, the patients are initially advised symptomatic treatment which temporarily relieves their complaints and diagnosis is delayed.

Among other advantages of early detection of cancer are also included cost effectiveness, less chances of disability and more chances of living useful healthy lives.

.Cancer patients are treated with a suitable combination of surgery, chemotherapy, and radiotherapy. Most of the patients need all the three modalities to achieve cure. One of the advantages of early detection of cancer is less mutilating and minimal curative surgery is possible.

Chemotherapy is the treatment of cancer with cytotoxic drugs which are generally injected in blood. These are repeated every 2-3 weeks depending on different protocols. One of the bothersome side effects of chemotherapy is loss of hair. But hair regrow within six months of completion of chemotherapy. Other side effects are also transient and manageable with the help of prophylactic medicines.

Radiotherapy is the treatment of cancer with the help of ionizing radiation. This sort of treatment is provided in controlled designated areas of the hospitals under supervision of trained doctors, scientists, and technologists. This treatment generally extends over several days depending on type of cancer and stage of the disease.

Cancer is generally known as a disease with roots as it has tendency to come back. Therefore, patients are advised to keep on visiting the doctor as and when suggested by the treating physician.

Together we can come up with strategy to cope with increasing incidence of cancer particularlyfemale cancers and bring improvement in early diagnosis and treatment for cancer control in the country.

 

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