Delivered lecture on Cancer Awareness in women- MVSR Engineering College,Nadergul. Mar 9, 2015

1. CANCER IN WOMEN
Dr. Sowjanya Kurakula
MBBS, MD
Obstetrician & Gynecologist

2. CANCER IS A
NON-COMMUNICABLE DISEASE
Major risk factors -

3. GLOBAL PROBLEM OF CANCER
45%
55%
INCIDENCE TOTAL 12
MILLION
DEVELOPED COUNTRIES DEVELOPING COUNTRIES
38%
62%
MORTALITY TOTAL 7.6
MILLION
DEVELOPED COUNTRIES DEVELOPING COUNTRIES

4. More than 1 million new cases of
cancer are diagnosed every year in a
population of 1.2 billion
this represents a combined male and female incidence
of about a quarter of that recorded in western Europe

5. An estimated 600,000-700,000
deaths in India were caused by
cancer in 2012

6. Many cancer cases in India are associated with
tobacco use,
infections,
and other avoidable causes.
Social factors, especially inequalities, are major
determinants of India's cancer burden,
with poorer people more likely to die from cancer
before the age of 70 years than those who are more
affluent

7. TOP FIVE CANCERS AMONGST WOMEN
BREAST
42%
COLORECTUM
8%
OVARY
8%
CERVIX
35%
ORAL CAVITY
7%
CANCER
BREAST COLORECTUM OVARY CERVIX ORAL CAVITY

8. CANCER- WORLDWIDE
55%
23%
22%
INCIDENCE
BREAST LUNG COLON/RECTUM
56%
44%
MORTALITY
LUNG BREAST

9. CANCER CERVIX

10. WHAT IS CERVICAL CANCER?
• IT IS A CANCER OF THE FEMALE REPRODUCTIVE TRACT
• PEAK AGE – BIMODAL, 35 & 50 YRS
• HUMAN PAPILLOMAVIRUS (HPV) INFECTION IS THE CAUSAL AGENT OF CERVICAL
CANCER.
• IT IS THE MOST COMMON CAUSE OF CANCER DEATH IN THE WORLD WHERE PAP
TESTS ARE NOT AVAILABLE
• IT IS THE EASIEST GYNECOLOGIC CANCER TO PREVENT THROUGH SCREENING
AND EARLY VACCINATION

12. CANCER OF CERVIX, VAGINAAND VULVA
RISK FACTORS
• YOUNG AGE AT FIRST INTERCOURSE (<16 YEARS)
• MULTIPLE SEXUAL PARTNERS
• CIGARETTE SMOKING
• RACE
• HIGH PARITY
• LOWER SOCIOECONOMIC STATUS

13. SYMPTOMS OF CERVIX AND VAGINA CANCER
• ABNORMAL VAGINAL BLEEDING
(POST COITAL BLEEDING/ POST MENOPAUSAL BLEEDING)
• FOUL SMELL VAGINAL DISCHARGE
• WEIGHT LOSS
• DIFFICULTY IN PASSING URINE

15. WHAT IS A PAP TEST?
• A TEST WHICH COLLECTS CELLS
FROM THE SURFACE OF THE CERVIX
AND LOOKS FOR ANY ABNORMAL
CELLS
• ABNORMAL CELLS CAN BE TREATED
BEFORE CERVICAL CANCER
DEVELOPS
• WHEN CANCER IS DETECTED EARLY,
IT IS EASIER
TO TREAT

16. WHAT IS A COLPOSCOPY?
COLPOSCOPY:
• USE OF A MAGNIFYING
INSTRUMENT
• APPLICATION OF A VINEGAR-LIKE
SOLUTION ONTO THE CERVIX
• SHOWS ABNORMALITIES THAT
CAN’T BE SEEN WITH THE NAKED
EYE
• FEELS LIKE GETTING A PAP TEST,
BUT TAKES A LONGER TIME
Source: This is a copyrighted image of the California
Family Health Council, Inc. and may not be
reproduced in any way without the expressed written
permission of the California Family Health Council.
California Department of Health Services "What You
Should Know if your Pap Test is Abnormal"- Your
Colposcopy Exam, Donna Bell Sanders (Education
Programs Associates 1995; Campbell, CA).

17. WHAT IS A CERVICAL BIOPSY?
BIOPSY:
• REMOVAL OF A SMALL PIECE
OF TISSUE FROM THE
CERVIX
• MAY FEEL LIKE GETTING A
PAP TEST OR LIKE A
MENSTRUAL CRAMP THAT
LASTS A FEW SECONDS
Source: TAP Pharmaceuticals,
“Female Reproductive Systems.”
Source: A. DeCherney and M. Pernoll,
Current Obstetric and Gynecologic
Diagnosis and Treatment (The
McGraw-Hill Companies, Inc.) 586.

18. CERVICAL CANCER VACCINE

19. WHAT IS THE CERVICAL CANCER VACCINE?
• THE CERVICAL CANCER VACCINE (ALSO KNOWN AS THE HUMAN PAPILLOMAVIRUS
OR HPV VACCINE) WILL HELP PREVENT CERVICAL CANCER BY PROVIDING
PROTECTION FROM THE ‘HIGH-RISK’ HPV VIRUS TYPES THAT CAUSE 70% OF
CERVICAL CANCER
• YOU CAN SIGNIFICANTLY DECREASE YOUR CHANCES OF GETTING CERVICAL CANCER
IF YOU GET THE VACCINE BEFORE INITIAL SEXUAL CONTACT
• THE BENEFIT OF THE VACCINE DECLINES WITH INCREASED HPV EXPOSURE

20. RECOMMENDED AGE GROUPS OF THE CERVICAL
CANCER VACCINE?
Girls 9-10
Eligible for the
vaccine
Girls 11-12
Recommended
age group to
receive the
cervical cancer
vaccine
Girls 13-18
Eligible to receive
the vaccine, if not
previously
vaccinated for
cervical cancer
Women 19-26*
Eligible for the
vaccine, if not
previously
vaccinated for
cervical cancer
Women 27-older
Not FDA
approved
Men
Not FDA approved
*The effectiveness of vaccine may be reduced
in this age group. The vaccine is less
effective with more prior HPV exposure.

21. IS THE CERVICAL CANCER VACCINE RIGHT FOR
ME?
• IF YOU ARE A FEMALE BETWEEN THE AGES OF 11 AND 12 THE
VACCINE HAS PROVEN BENEFIT FOR YOU
• IF YOU STARTED HAVING SEX, YOU CAN STILL GET THE VACCINE,
BUT THE BENEFIT FROM THE VACCINE MAY BE LOWER BECAUSE
YOU MAY HAVE ALREADY BEEN EXPOSED TO HPV
• THE VACCINE DOES NOT WORK TO ELIMINATE CURRENT HPV
INFECTIONS
• THE VACCINE ONLY PREVENTS CERTAIN TYPES OF HPV INFECTION
• EARLY VACCINATION, REGULAR PAP TESTS AND HPV TESTS WHEN
RECOMMENDED BY A HEALTHCARE PROVIDER WILL PROVIDE YOU
WITH YOUR BEST PROTECTION AGAINST CERVICAL CANCER

22. WHAT SHOULD I EXPECT AT MY VACCINE
APPOINTMENT?
• YOU WILL NEED A SERIES OF THREE APPOINTMENTS OVER 6 MONTHS
• YOU WILL RECEIVE A SHOT, USUALLY IN THE UPPER ARM, AT EACH OF THE
THREE APPOINTMENTS
• COMMON SIDE EFFECTS INCLUDE:
• A SORE ARM FOR A DAY OR TWO AFTER THE VACCINE SHOT
• A HEADACHE AND/OR A LOW GRADE FEVER
• YOU CAN USE OVER THE COUNTER PAIN AND FEVER MEDICATIONS IF NEEDED
• YOU SHOULD NOT GET THE VACCINE IF YOU ARE PREGNANT OR TRYING TO GET
PREGNANT

23. HEPATITIS-B VACCINE PREVENTS LIVER
CANCER

24. BREAST CANCER
BREAST CANCER ACCOUNTS FOR ONE
THIRD OF CANCERS IN WOMEN
• THE RISK INCREASES WITH A POSITIVE
FAMILY HISTORY AND THE USE OF
HORMONE THERAPY
• CONSTITUTES THE MOST COMMON CAUSE
OF CANCER DEATH IN INDIA

25. RISK FACTORS OF BREAST CANCER
• AGE
• FAMILY HISTORY
• HIGH FAT INTAKE IN DIET
• OBESITY
• ALCOHOL (WINE)
• EARLY MENARCHE
• EARLY MENOPAUSE IS PROTECTIVE
• NULLIPARITY
• HIGHER AGE AT 1ST CHILD BIRTH
• H/O OVARIAN AND COLON CANCER
• RADIATION THERAPY

29. BREAST CANCER
• DIAGNOSIS
• BIL MAMMOGRAPHY
• CXR
• BLOOD INV
• CT/MRI
• TREATMENT
• SURGERY
• RADIOTHERAPY
• CHEMOTHERAPY

30. You can reduce
your risk for
breast cancer by
adopting a
balanced
lifestyle and
avoiding
environmental
carcinogens
(cancer causing
substances)
Although
very rare,
men can also
develop
breast
cancer
Most women
who have
many risk
factors never
develop
breast
cancer
Women who
breastfeed for
at least 18
months can
further reduce
their (and their
baby’s) risk
Be
physically
active, don’t
be
overweight
and limit
your alcohol
intake

32. OVARIAN AND FALLOPIAN TUBE CANCER
• POST MENOPAUSAL AGE
• STRONG FAMILY HISTORY
• H/O BREAST / COLON CANCER
• OFTEN DIAGNOSED LATE

33. RISK FACTORS FOR OVARIAN CANCER
• LOW PARITY
• INFERTILITY

34. PREVENTION OF OVARIAN CANCER
• HAVING AT LEAST ONE CHILD IS PROTECTIVE
• ORAL CONTRACEPTIVE USAGE

35. SCREENING OF OVARIAN CANCER
PERIODIC GYNECOLOGIC EXAMINATION
HIGH RISK INDIVIDUALS ARE OFFERED
• GENETIC COUNSELING
• GENETIC TESTING FOR BRCA1AND BRCA2.
• TRANSVAGINAL ULTRASONOGRAPHY EVERY 6 MONTHS
• ORAL CONTRACEPTIVES SHOULD BE RECOMMENDED TO WOMEN SEEKING
CONTRACEPTION
• PROPHYLACTIC BILATERAL SALPINGO-OOPHORECTOMY
• WOMEN WITH STRONG FAMILY HISTORY OF BREAST OR OVARIAN CANCER,
ANNUAL MAMMOGRAPHIC SCREENING
• WOMEN WITH A DOCUMENTED HNPCC SYNDROME
PERIODIC SCREENING MAMMOGRAPHY, COLONOSCOPY, AND ENDOMETRIAL BIOPSY

36. SYMPTOMS OF OVARIAN CANCER
MAJORITY- VAGUE AND NON-SPECIFIC SYMPTOMS
• ABNORMAL VAGINAL BLEEDING IN POST MENOPAUSAL GROUP
• CONSTIPATION
• FREQUENT URINATION
• LOWER ABDOMINAL PAIN AND DISTENSION
• PAIN DURING SEX

37. OVARIAN CANCER
• DIAGNOSIS
• USG
• CT
• LOWER GI SERIES
• IVP
• CA125
• BIOPSY
• TREATMENT
• SURGERY
• CHEMOTHERAPY
• RADIOTHERAPY

38. UTERINE CANCER

39. RISK FACTORS FOR UTERINE CANCER
• NULLIPARITY
• LATE MENOPAUSE
• OBESITY
• DIABETES
• UNOPPOSED ESTROGENS
• TAMOXIFEN THERAPY
• ATYPICAL ENDOMETRIAL HYPERPLASIA
• HEREDITARY NONPOLYPOSIS COLORECTAL CANCER

40. SCREENING OF UTERINE CANCER
• LIMITED TO HIGH RISK INDIVIDUALS
• ENDOMETRIAL BIOPSY DONE IN SUSPECTED CASES

41. SYMPTOMS OF UTERINE CANCER
• ABNORMAL VAGINAL BLEEDING OR FOUL SMELL DISCHARGE
(PERI/POST MENOPAUSAL AGE GROUP)
• LOWER ABDOMINAL PAIN
• ASYMPTOMATIC
OVERALL 5-YEAR SURVIVAL RATE IN ENDOMETRIAL CANCER IS APPROXIMATELY 75%

42. UTERINE CANCER
• DIAGNOSIS
• PELVIC EXAMINATION
• PAP SMEAR
• EM BIOPSY
• TVS
• TREATMENT
• SURGERY
• RADIATION THERAPY
• CHEMOTHERAPY
• HORMONE THERAPY

43. VULVA CANCER
• VULVAR LESIONS REQUIRE BIOPSY TO AVOID DELAY IN DIAGNOSIS

44. RISK FACTORS FOR VULVA CANCER
• YOUNG AGE AT FIRST INTERCOURSE (<16 YEARS)
• MULTIPLE SEXUAL PARTNERS
• CIGARETTE SMOKING
• RACE
• HIGH PARITY
• LOWER SOCIOECONOMIC STATUS.
• H/O MULTIPLE GENITAL TRACT MALIGNANCIES
• IMMUNOSUPPRESSION

45. SYMPTOMS OF VULVA CANCER
POST MENOPAUSAL LADY
• LONG STANDING WHITE PATCH
• NON- HEALING ULCER
• VULVA ITCHING
• FOUL SMELL DISCHARGE
• PAIN OVER VULVA
• DIFFICULTY IN URINATION
• SWELLING IN GROIN

46. VULVA CANCER
• DIAGNOSIS
• PELVIC EXAMINATION
• COLPOSCOPY
• PAP SMEAR
• BIOPSY
• TREATMENT
• SURGERY
• CHEMOTHERAPY
• RADIOTHERAPY

47. GESTATIONAL TROPHOBLASTIC TUMORS
MOLAR PREGNANCY
• AGE > 35 WITH PERSISTENT BLEEDING AFTER D&C IN MOLAR PREGNANCY CAN
PREDISPOSE TO UTERINE CANCER

48. COLORECTAL CANCER
• ANY ADULT CAN HAVE COLORECTAL CANCERS (CANCERS OF THE COLON AND
RECTUM) BUT MOST OF THESE CANCERS ARE FOUND IN PEOPLE AGE 50 OR
OLDER.
• PEOPLE WITH A
• PERSONAL OR FAMILY HISTORY OF THIS CANCER,
• OR WHO HAVE POLYPS IN THEIR COLON OR RECTUM,
• OR THOSE WITH INFLAMMATORY BOWEL DISEASE ARE MORE LIKELY TO
HAVE COLORECTAL CANCER.
• ALSO, EATING A DIET MOSTLY OF HIGH-FAT FOODS (ESPECIALLY FROM ANIMAL
SOURCES),
• BEING OVERWEIGHT,
• SMOKING,
• PHYSICAL INACTIVITY

50. LUNG CANCER
• SMOKING IS THE CAUSE OF MORE THAN 80% OF ALL LUNG CANCERS, BUT PEOPLE
WHO DON’T SMOKE CAN ALSO HAVE LUNG CANCER.
WHAT YOU CAN DO
• LUNG CANCER IS ONE OF THE FEW CANCERS THAT CAN OFTEN BE PREVENTED
SIMPLY BY NOT SMOKING.
• IF YOU ARE A SMOKER, ASK YOUR DOCTOR OR NURSE TO HELP YOU QUIT.
• IF YOU DON’T SMOKE, DON’T START, AND AVOID BREATHING IN OTHER PEOPLE’S
SMOKE.
• IF YOUR FRIENDS AND LOVED ONES ARE SMOKERS, HELP THEM QUIT.

51. SKIN CANCER
• ANYONE WHO SPENDS TIME IN THE SUN CAN GET SKIN CANCER.
• PEOPLE WITH FAIR SKIN, ARE MORE LIKELY TO GET IT THAN PEOPLE WITH DARKER
COLORING.
• PEOPLE WHO HAVE HAD A CLOSE FAMILY MEMBER WITH MELANOMAAND THOSE WHO
HAD BAD SUNBURNS BEFORE AGE 18 ARE MORE LIKELY TO GET SKIN CANCER.
WHAT YOU CAN DO
• MOST SKIN CANCERS CAN BE PREVENTED BY STAYING OUT OF THE MIDDAY SUN.
• WHEN IN THE SUN, WEAR HATS WITH BRIMS, LONG-SLEEVE SHIRTS, SUNGLASSES, AND USE
SUNSCREEN WITH AN SPF OF 30 OR HIGHER ON ALL EXPOSED SKIN.
• IF YOU HAVE CHILDREN, PROTECT THEM FROM THE SUN AND DON’T LET THEM GET
SUNBURNED.
• BE AWARE OF ALL MOLES AND SPOTS ON YOUR SKIN, AND REPORT ANY CHANGES TO A
DOCTOR RIGHT AWAY.
• HAVE A SKIN EXAM DURING YOUR REGULAR HEALTH CHECK-UPS.

52. TOBACCO
CAUSES
CANCER

53. SMOKING
CAUSES
CANCER

68. THE BEST DEFENSE AGAINST CANCER
Early detection –
finding a cancer early,
before it has spread –
gives you the best chance to do something about it.
Knowing about these cancers and
what you can do to help reduce
your cancer risk
can save your life.

70. COMMONEST CANCER IN
WOMEN WORLWIDE

71. MOST COMMON CANCER IN
WOMEN IN INDIA

72. SECOND COMMONEST
CANCER AMONGST WOMEN
IN INDIA

73. GENITAL CANCER WITH GOOD
OUTCOME

74. GENITAL CANCER WITH WORST
OUTCOME

75. MOST COMMON CAUSE OF CANCER
DEATH IN INDIA

76. BLEEDING AFTER SEX

77. SILENT KILLER CANCER