Gynecological Cancers in Women : a brief overview

Introduction

Of the non-communicable diseases that assail the population, cancer is the second leading cause of mortality, second only to cardiovascular disease.  

Of the newly diagnosed 13.89 lakhs cases in India annually, 7.87 lakhs were women alone. Cancer in women is, therefore, a major cause of morbidity/mortality in our country and must be dealt with appropriately. These numbers grow starker when the 5-year prevalence rates are considered. Female cancer cases then constitute over 55% of the country’s total cancer burden.

Common cancers in womenfolk in India

Indian women are most likely to be afflicted by breast, cervical, ovarian, oral, and colorectal cancer, in that order. Timely diagnosis becomes ever more important as these cancers are more amenable to treatment when detected and treated at an early stage. To ensure that, the importance of symptom awareness, cancer screenings, and effective treatment cannot be stressed enough. 

We’ll be discussing these in some detail.

Breast cancer: The most common form, breast cancer alone accounts for nearly 30 % of all. Some of the symptoms include breast lumps, bloody/serous nipple discharge, inversion of nipples, and changes in size/shape of breasts and nipples. The risk factors include increased estrogen exposure, excess alcohol consumption, and genetic mutations. 

BRCA gene mutation confers an increased risk of both breast and cervical cancer.

While breast self-exam is recommended, it often misses the early symptoms and thus annual medical checkup becomes imperative. Women with a family history of breast cancer should begin these screenings early.

USG/Mammogram is employed based on the patient’s age.

At 45-50 years, the average age for breast cancer in India is almost a decade lower than that in the west where the average age for the onset of breast and ovarian cancers is 60 years. In India, risk factors such as high-fat diets and obesity have also added to the number of breast cancer cases. 

Cervical cancer: This accounts for 22 % of the cancer burden. Some of the symptoms include abnormal vaginal bleeding – inter-menstrual, post-coital and post-menopausal as well as a cervical mass. Later in the disease course, the tumor may invade into the neighboring structures like ureters, causing urinary problems. Human papillomavirus, spread through unsafe sexual practices and poor hygiene is the major cause of cervical cancer. Keeping that in mind, HPV vaccination offers a safe and reliable way to prevent this. Western countries have reduced the burden of cervical cancer significantly, by employing robust vaccination strategies Smoking and immunosuppression also compound the risk.

Annual pap smears can pick up premalignant lesions and are a great way to detect cancer early.

Rural women are known to be at higher risk of developing cervical cancer as compared to their urban counterparts.

Ovarian cancer: Though only 2.5 % of the total cancers, ovarian cancer warrants a discussion here. Often asymptomatic early in its course, abdominal bloating and heaviness, urinary urgency are some of the symptoms. Risk factors include nulliparity, lack of breastfeeding, and genetic mutations. More education needs to be disseminated at government and private levels.

Endometrial cancer: This often presents with abnormal post-menopausal bleeding. The risk factors include increased estrogen exposure in the form of obesity, early menarche, late menopause, and PCOS. Any bleeding out of regular cycles should be promptly investigated medically. 

India fighting cancer

According to a report released by the Indian Council of Medical Research (ICMR) in 2018, cancer took more than 700,000 lives in India. 

India has seen a sharp rise in cancer-related fatalities. Nearly 70% of the healthcare expenses are out of pocket – most patients lack insurance cover, precluding them from the best treatments available. There is an acute shortage of trained oncologists and hospitals. Still, there lies hope. 

Many companies are now investing in healthcare startups that are working on drug discovery and those involved in improving cancer healthcare delivery. Some are working on life-saving medications, but there are also attempts at trying to fill the gaps in every step of the way. From using Artificial intelligence to diagnose cancer at an early stage, to enabling patients to access oncologists from the comforts of their homes. 

 Niramai Health Analytix, a Bangalore-based company, has developed a novel software-based medical device to detect breast cancer at a much earlier stage than traditional methods. Their solution is accurate, portable, and very affordable compared to other screening devices like mammograms. Their imaging method is radiation-free, non-touch, not painful, and works for women of all ages(unlike mammograms whose results are equivocal in women with dense breast tissue). Niramai’s technology has been adopted by many top healthcare institutions in the country and is also being used in many government PHCs. 

Tzar Labs – Tzar Labs, a molecular diagnostic company, has developed technology for early detection of cancer. It has worked out a blood test, which can determine whether cancer is present, imminent, or absent in a patient, thus aiding doctors in planning treatment protocols. 

ONCHO – Inspired by her experience, Rashie Jain in 2017 founded Onco.com, a healthcare technology company focused on providing end-to-end care management services to cancer patients. The platform provides a seamless experience by having built an online oncology ecosystem that the patients/families can tap into. They are offered personalized advice and treatment strategies, thereby making this whole process more patient-centric.

Conclusion: As seen, cancer is a cause of much morbidity and mortality in the country, adding to the healthcare and economic burden significantly. Women, when affected are even less likely to receive an early diagnosis and treatment due to the stigma attached. It is incumbent upon healthcare workers, researchers and even the general public to raise awareness regarding the same.

Apart from government flagship schemes, the rise of various startups in the sector is heartening, and we hope that the coming decades see a significant drop in cancer-related suffering.

We owe this to our women.

Authors:

Pratik is a Research Engineer at Niramai Health Analytix. Pratik writes on everything that connects healthcare to technology and runs a weekly newsletter on healthcare.

Shreya is an MBBS graduate, with a keen interest in psychiatry and Public health. Outside of work, she likes reading, playing with dogs, and hiking.