Más contenido relacionado


screening of cancers

  1. Screening for CANCERS Dr. Shobha dhananjaya Professor in OBG JJMMC, DVG
  2. Definition: • ‘Screening’ means looking for early signs of a particular disease in healthy people who do not have any symptoms. • Screening cannot prevent cancer, it can only find it as early as possible and help in early radical cures.
  3. • Breast cancer • Cervical cancer • Endometrial (uterine) cancer • Ovarian cancer
  4. Overview of Breast Cancer
  5. Breast Cancer Facts  2nd leading cause of death  2nd most common cancer  Incidence increases with age  All women are at risk
  6. Types of Breast Cancer Ductal Carcinoma common Lobular Carcinoma rare
  7. What causes Breast cancer • 90% of breast cancers are due to genetic abnormalities- aging process and the “wear and tear” of life. • 5-10% of cancers are due to an abnormality inherited from your mother or father.
  8. Risk Factors for Breast Cancer Gender: female (1% males) Race: more common in whites Age: increases as a woman gets older. Relative : (mother or sister) Menstrual history :early onset, late menopause Childbirth: first child After the age of 35 or having no children at all Pregnancy and breastfeeding are protective against breast cancer
  9. Risk Factors for Breast Cancer Obesity Diet: Fat Alcohol Lack of Physical Activity ; Stress Radiation Exposure History of cancer: breast, uterus, cervix, ovary Hormones: estrogens in Hormone replacement therapy & Birth control pills > 70% have no risk factors
  10. Symptoms of Breast Cancer Early breast cancer may not have symptoms.
  11. Diagnosis of Breast Cancer
  12. Prevention Breast Cancer Risk Factors thatcan be controlled All women are at risk Obesity Exercise Breastfeeding Alcohol Hormone Replacement Therapy Not having children
  13. Screening For Breast Cancer A GoodBreast Health Plan • Self Awareness- Monthly Self Exams • Clinical Breast Examination • Mammograms
  14. Screening Average-size lump found by woman practicing occasional breast self-exam (BSE) Average-size lump found by woman practicing regular breast self-exam (BSE) Average-size lump found by first mammogram Average-size lump found by getting regular mammograms r i z
  15. Breast Self Examination (BSE) • Opportunity for woman to become familiar with her breasts • Monthly exam of the breasts and underarm area • May discover any changes early • Begin at age 20, continue monthly
  16. When to do BSE • Menstruating women- 5 to 7 days after the beginning of their period • Menopausal women - same date each month • Pregnant women – same date each month • Takes about 10 minutes • Perform BSE at least once a month • Examine all breast tissue
  17. Why don’t more women practice BSE • Fear • Embarrassment • Youth • Lack of knowledge • Too busy, forgetfulness
  18. Clinical Breast Examination • Performed by doctor or trained nurse practitioner • Annually for women over 40yrs • At least every 3 years for women between 20 and 40 yrs • More frequent examination for high risk patients
  19. Mammography  X-ray of the breast save lives in patients 50-70%  Normal mammogram does not rule out possibility of cancer completely
  20. Women (asymptomatic) 40 years of age and more should have a MAMMOGRAM every year.
  21. Treatment for Breast Cancer • Surgery • Radiation Therapy • Chemotherapy • Hormonal Therapy
  22. Breast Reconstruction Post surgical Expanders and Implant
  23. Tissue and Implants Combined
  24. Prognosis after Breast Cancer 5-Year Survival (%) 10-Year Survival (%) Stage 0 95 90 Stage I 85 70 Stage II 70 50 Stage III 55 30 Stage IV 5 2
  25. Myths•Touching the breasts too often will lead to cancer •Talking about cancer causes cancer •Using illegal drugs causes cancer •Herbs cure breast cancer •A bruise on the breast will lead to breast cancer. •If an incision is made during breast cancer surgery the cancer will spread. •Getting too many mammograms leads to breast cancer. •A breast cancer diagnosis is an automatic death sentence.
  26. Facts• Breast cancer commonly affects older women • If you have a risk factor for breast cancer, you're likely to get the disease • Mammograms are only used to evaluate breast lumps. • Breast cancer is preventable
  27. • Cervical cancer is the most common cancer in women in developing countries. • Lowermost portion of the uterus (neck of the womb)
  28. • Biopsy — Removal of a small sample of tissue for examination under a microscope; used for the diagnosis and treatment of cervical cancer and precancerous conditions. • Carcinoma in situ — Cancer that is confined to the cells in which it originated and has not spread to other tissues.
  29. CERVICAL CANCER: • Cervical cancer is a malignant tumour arising from the cells of the neck of the womb which is the lower part of the female reproductive organ.
  30. Human papillomavirus( 90%) –STI Multiple sexual partners Sexual relation before the age of 18
  31. • Smoking • Weakened immune system • Several pregnancies • Giving birth at a very young age • Long-term use of the contraceptive pill
  32. • Post coital bleeding • White discharge • Pelvic pain • Cachexia
  33. PAP test
  34. • HPV DNA test • HPV DNA test involves collecting cells from the cervix for lab testing.
  35. • CT (computerized tomography) scan • MRI (magnetic resonance imaging scan) • Pelvic ultrasound
  36. • Chemotherapy Chemotherapy is the use of chemicals (medication) to destroy cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing
  37. • Radiotherapy Radiotherapy works by damaging the DNA inside the tumor cells,
  38. –Laser surgery - a narrow beam of intense light destroys cancerous and precancerous cells. –LEEP (loop electrosurgical excision procedure) - a wire loop which has an electric current cuts through tissue removing cells from the mouth of the cervix.
  39. – Flavonoids are chemical compounds in fruits and vegetables that are thought to be a leading source protection against cancer. The flavonoid-rich foods are Apples, Black beans, Broccoli, Brussels sprouts, Cabbage, Garlic, Onions, Soy, Spinach.
  40. – Folate (a water-soluble B vitamin) reduce the risk of cervical cancer in people with HPV. Foods rich in folate include breads, Lentils, Orange juice and Strawberries . – Carotenoids, a source of vitamin A, are also helpful in preventing cervical cancer risk. Foods such as carrots, sweet potatoes and pumpkin are rich in vit. A.
  41. HPV (human papilloma virus) vaccine • 3-doses ( 0-1-6 months ) • CERVIREX
  42. –Safe sex –Cervical screening – avoid multiple sexual partners –Delay first sexual intercourse –avoid smoking
  43. INTRODUCTION Incidence of endometrial cancer is very low in India. Highest in Delhi – 4.3/ lac Bangalore – 4.2/ lac Mumbai – 2.8/ lac (GLOBOCAN - 2008)
  44. 21-50 lb over wt.- 3 times >50 lb over wt.- 10 times Most common cause of endogenous production of estrogen (Williams gyne) Coexisting medical condition / sequele- HTN, DM & Gall bladder disease increases risk (Williams gyne)
  45. obesity Corpus cancer Corpus cancer syndrome
  46. Risk also increases with : > Duration of therapy > Cumulative dose
  47. Preventing factors Oral contraceptive pills- 1 yr. of use confirms 30% reduced risk Risk reduction is upto 10-20 yrs. Progestin component has chemo protective role Progesterone IUCDs confirms long term protection. Earlier age of menopause
  48. Screening tests  Pap smear  Progesterone challenge test  TVS  Endometrial biopsy  VABRA or Pipelle
  49. EARLY DIAGNOSIS & TREATMENT If a lady comes with:  Premenopausal AUB  Post menopausal bleeding per vagina 25% of the endometrial cancer occurs premenopausally. 5% under the age of 40 yrs. Early diagnosis & prompt treatment has high cure rate.
  50. 10% (HNPCC or predisposition for endometrial cancer alone) Autosomal dominant What to do in these patients ??? There are 2 alternatives- Annual pelvic examination, TVS & EB from the age of 30-35yrs. OR Prophylactic TAH & BSO after completion of child bearing (Preferred Alternative)
  51. Endometroid adenocarcinoma • ~80% of endometroid carcinoma • Composed of glands that resemble normal endometrial gland • D/d- Atypical hyperplasia- Differentiated by presence of invasion.
  52. Simultaneous tumors of endometrium & ovary Most frequent simultaneously occurring genital malignancies Incidence- 2-4% Both are well differentiated Prognosis -Excellent Mostly postmenopausal C/f : AUB (ovarian ca diagnosed incidentally) 29% of endometroid adeno ca. of ovary have associated endometrial cancer.
  53. Clinical features Average age of presentation- 60 yrs. Mostly 6th & 7th decades of life. 5% presents premenopausally (Novaks 15th ed.) Presenting symptoms: Vaginal bleeding Vaginal discharge (may be purulent) Pelvic discomfort/ pain (due to uterine enlargement due to mass or hematometra or pyometra or extrauterine d/s spread) < 5% - Asymptomatic
  54. Causes of post menopausal BPV ??? Post menopausal BPV Genital Uterine Endo. Atrophy(60-80%) Estrogen replacement (15-25%) Endo. Hyperplasia (5-10%) Endo. polyp (2-12%) Endometrial Ca (10%) Extra-uterine Ca. cervix, vagina & vulva Atrophic vaginitis Traumatic bleeding Non-genital Urinary Gastro intestinal Hematological
  55. History &Physical examination History: Obesity, Diabetes, Hypertension, bladder & bowel symptoms Gen. Examination: Weight LN enlargement (Inguinal, abdominal) Breast examination P/A exam: +ve in advanced disease Ascites Hepatic or omental metastasis Pelvic exam: Vaginal introitus, sub urethral area, vagina, cervix P/V exam., P/R exam. (uterus, adenexa, parametrium, cul-de-sac)
  56. investigations Routine investigations Transvaginal sonography* Office based endometrial biopsy (VABRA or Pipelle)* Endocervical curettage (in suspected cervical pathology) Hysteroscopy Dilatation & Curettage Only used if there is: Cervical stenosis Recurrence of bleeding after –ve OBEB Inadequate sampling in specimen
  57. Pre treatment evaluation Examination: Routine investigations: ECG Chest X-ray CA-125- ↑sed in advanced metastatic Ca. USG & MRI- Degree of invasion Cystoscopy, Colonoscopy, IVP, Barium enema- acc. to symptoms
  58. Surgical Staging Hysterectomy B/L Salpingo-oopherectomy Biopsy of all metastatic deposits Peritoneal fluid cytology Cytology in clockwise fashion Pelvic & Para-aortic LN dissection only in high risk- Tumor size >2cm. Grade-III tumor Non endometroid tumor
  59. treatment Exploratory laparotomy Biopsy of any suspicious lesion TAH-BSO Peritoneal cytology Resect any enlarged LN Selective Pelvic & Para-aortic lymphadenopathy
  60. Follow up History & Physical examination (Most effective method): 1st 2 yrs.- Every 3-4 mths Then- Every 6 mths  Chest X-Ray: Every year  CA-125: For patients : Who have elevated CA-125 @ the time of diagnosis Have extrauterine disease
  61. Recurrent disease ~25% of the treated early endometrial cancer recurs. >50% recurs in 1st 2 years ~75% recurs in 1st 3 years
  62. Points to remember Recurrence is less when the surgery +radiotherapy Metastasis to.- Lung, Abdomen, Lymph nodes (Aortic, Supraclavicular, Inguinal), Liver, Brain & Bone
  63. Clinical features
  64. Ovarian Cancer 91
  65. Introduction.  Cancer cell growth is different from normal cell growth. 1. Instead of dying, cancer cells continue to grow and form new& abnormal cells. 2. Cancer cells can also invade (grow into) other tissues, Why the Cells become cancerous ??? Due to damage in DNA. 92
  66. Anatomy and physiology 93 female organs (glands producing sex hormones and the ova) size: One ovary is long, 2 cm wide and 1 cm thick Shape: almond shape. Location: on each side of the uterus
  67. Symptoms Early symptoms of ovarian cancer: •Pain in the pelvis •Back pain •Indigestion or heartburn •More frequent and urgent urination •Pain during sexual intercourse As ovarian cancer progresses these symptoms are also possible: •Nausea, Weight loss, Breathlessness, Fatigue (tiredness) •Loss of appetite
  68. Causes  Family history  - Age  - High number of total lifetime ovulations.  - Early start of menstruation and Late start of menopause .  - Breast cancer. - HRT (Hormone replacement therapy) . - Obesity/overweight. - Endometriosis. - Inherited genetic syndromes. 96
  69. Stages stage:1 97
  70. Stage:2 98
  71. Stage: 3 99
  72. Stage:4 100
  73. Diagnosis of ovarian cancer The following tests are used to diagnose ovarian cancer:  Blood test  Ultrasound  Laparoscopy and possibly Endoscopy  Abdominal fluid aspiration  Chest X-ray  CT (computerized tomography) scan  MRI (magnetic resonance imaging) scan  Positron emission tomography (PET scan)  Biopsy 103
  74. Treatment Treatment for ovarian cancer consists of 2.chemotherapy 3.combination of surgery with chemotherapy 4.radiotherapy 104
  75. Side effects of chemotherapy  Diarrhoea.  Hair loss.  Loss of appetite.  Mouth sores.  Anaemia. 106
  76. RADIOTHERAPY Side effects - •Bladder infections. •Diarrhea, Constipation. •Irritation, darkening of your skin •Nausea, Frequent urination, Abdominal pain PREVENTION: Oral contraceptives Gynaecologic surgery •tubal ligation •hysterectomy 107
  77. Conclusion  ovarian cancer is less common and early diagnosis may save lives.  symptoms are similar to that of irritable bowel syndrome, pre-menopause, endometriosis, gall bladder disease  It is the time to BREAK THE SILENCE….. educate yourself and the women you love !!! 108
  78. Thank you 109