Surgery is a major event in life. its best taken with utmost seriousness to avoid errors.
Investigations: Please remember to carry all of them with you.
CBC/ hemogram,
LFT [liver function tests],
RFT [renal / kidney function tests],
PT,PTT,INR [coagulation profile],
BG: blood group
Random blood sugar, Urine routine examination,
Viral markers: HIV, HCV, HBsAg,
Cardiac assessment: Chest X Ray, ECG, 2D ECHO
Other tests as per individual risk factors
Biopsy or FNAC report
Mammography or sonomammography report and film
USG abdomen and pelvis [if advised by Dr]
Bone scan [if advised by Dr]
Whole body PET CT scan [if advised by Dr]
Fitness evaluation from Physician and anesthesiologist
Declare:
Previous surgeries– be it any,
Allergies: drug allergy, sticking allergy or any substance allergy.
Comorbidities like hypertension or high BP, diabetes, previous heart attack, arrhythmias, previous cardiac stenting or bypass surgery, asthma etc
If you are taking blood thinner [commonly used being aspirin or clopidogrel], it needs to be stopped at least 5 days prior with your cardiologist’s advice.
Policy for blood reservation: usually blood transfusions are not needed in this surgery unless the patient has anemia in pre op assessments. However on saer side blood is reserved so it can be given in untoward emergencies.
Breast Cancer Surgery Preparation checklist:
Pre-Operative
Blood thinners: Stop aspirin or aspirin like products prior to the surgery.
Nil by mouth: Nothing to eat or drink after 12 midnight: the night before surgery or minimum 8 hrs prior to surgery. NOT EVEN WATER
Shower:
Shower the night before and the day of surgery.
• Use approximately one ounce of antiseptic soap (CHLORHEXIDINE OR SAVLON soap : 30 ml), washing below the neck only. You may use your regular soap / shower gel or shampoo for face and hair.
• Rinse well.
• Repeat above steps.
• Use a freshly laundered towel to dry off after each shower.
• Put on freshly laundered garments (night clothes, underwear, etc.).
Arrange for a family member, friend or escort to bring you to the surgical procedure and take you home.
The secretary from the Suyog Cancer clinic or RMO doctor will get in touch with you in the evening before surgery to confirm time and location for check in for your surgery. If you have not received a call by 4 p.m., you may call on 9819073781 .
Please discuss any medications you usually take in the morning with the on duty RMO at hospital.
Day of Surgery
Leave jewelry and valuables at home. NO METAL ELEMENT ON BODY DURING SURGERY like chain, ear ring or rings in toes, bracelet etc
Wear your glasses instead of contacts if you have them.
Please do not use deodorant or lotions on your skin and nail paints too.
Avoid using hair spray or gel.
Wear comfortable clothing.
Remind staff nurses not to use the hand on the surgical side for IV cannula i.e. if one has right breast cancer then no cannula on right upper limb.
Understand about the types of breast cancer surgeries:
Lumpectomy: Your tumour (lump) and a small amount of normal breast tissue around the tumour was removed.
Mastectomy: Your whole breast was removed.
Axillary lymph node dissection: Most (lower two thirds) of the lymph nodes under your arm were removed to:1]check if the cancer spread from your breast to the lymph nodes under your arm 2]remove any cancer that may have spread to your lymph nodes. This reduces the risk of cancer coming back in armpit.
Radical or modified radical mastectomy [RM/MRM]: this involves radical removal of breast with tumor in toto and axillary dissection as described above. In this surgery the contour and substance of the breast is lost. For reconstruction after such surgery one may choose doing skin sparing mastectomy [SSM] with reconstruction using flaps or prosthetic material or both.
Breast conservation surgery[BCS]: this involved wide lumpectomy or removal of palpable mass in breast with certain amount of adjacent breast tissue and leaves behind the rest of breast. It also involves axillary dissection which means removal of lymph nodes along with fibrofatty tissues from armpit [where this cancer can spread or could have spread]. This may be followed by refashioning breast tissue for better form and shape to breast which is called oncoplasty. The reconstruction may as well involve usage of tissue from outside breasts like LD flap or prosthetic material like implants. Radiation to the remaining or conserved breast is a must after breast conservation surgery.
Robotic breast surgery:
Nipple sparing mastectomy can now be done using a surgical robot with added precision, thanks to the magnification and visualization of detailed anatomy in robotic surgery. the reconstruction can be done the same time and it can be implant based or autologous tissue based .
Sentinel lymph node biopsy: This helps find out whether breast cancer has spread to lymph nodes under your arm. The sentinel nodes may be the first lymph nodes your tumour drains into. If the sentinel nodes have cancer cells, then more lymph nodes may need to be removed. And if sentinel node is negative on intraop frozen section assessment, further axillary dissection may not be warranted.
The best suitable surgery for any patient revolves around following factors:
Tumour size and location
Tumor to breast size ratio
Patient’s desire for conservation or radical removal of breast
Age, comorbidities, willingness and feasibility of radiation etc
Telomeres are protective caps located at the ends of linear chromosomes, acting similarly to the plastic tips (aglets) on shoelaces that prevent the lace from fraying.
What is their Function?
Their primary role is to maintain genomic stability by preventing chromosome degradation or fusions during cell division.
Telomere Disorders and Dysfunction
Telomere health is a delicate balance; disruptions in their length or structure can lead to severe cellular disorders.
1. Natural Shortening: Due to the “end-replication problem,” DNA polymerase cannot fully replicate the very ends of chromosomes, causing telomeres to lose a small portion with every division.
2. Telomere Fragility: This is characterized by structural abnormalities or gaps in the DNA, often caused by replication stress (e.g., stalled replication forks or G-quadruplex structures).
3. Abnormal Lengths: Both critically short and unusually long telomeres contribute to disease risks. For instance, certain cancers use an Alternative Lengthening of Telomeres (ALT) mechanism to maintain excessive length.
What is its Result on Ageing and Cancer?
Telomeres act as the critical interface between these two biological processes.
• Ageing:
When telomeres reach a “critically short” length, they trigger cellular senescence (a permanent stop in division) or apoptosis. These senescent cells secrete inflammatory signals (SASP), leading to “inflammaging” and tissue degeneration.
• Cancer:
◦ Initiation: Short telomeres cause chromosomal instability, leading to fusions and mutations that activate oncogenes or inactivate tumor suppressor genes like p53.
◦ Progression: To achieve cellular immortality, roughly 90% of cancer cells reactivate telomerase (an enzyme that extends telomeres), allowing for unlimited replication and metastasis.
FACTORS AND DIETARY INTERVENTIONS
Factors Accelerating Telomere Erosion
Several internal and external stressors contribute to the rapid “ticking” of our biological clock.
• Biological Stress: Reactive Oxygen Species (ROS) from metabolism and chronic low-grade inflammation.
• Lifestyle & Environment: Smoking, lack of physical exercise, and UV radiation.
• Psychological Stress: Chronic stress (e.g., long-term caregiving) can biologically age cells by the equivalent of 10 years compared to lower-stress individuals.
The “Nobel” Diet: Nutrients that Protect DNA
Research suggests that specific dietary choices can increase telomerase activity by 29% to 84%.
• Omega-3 Fatty Acids: Found in wild-caught salmon, sardines, walnuts, and flax seeds, high blood levels are linked to slower telomere shortening.
• Antioxidant-Rich Foods: Blueberries, strawberries, and blackberries provide anthocyanins that reduce DNA damage.
• Protective Vegetables: Spinach, kale, and broccoli offer folate (essential for DNA repair) and Vitamin C. Colorful bell peppers provide carotenoids, which correlate with significantly longer telomeres.
• The Power of Vitamin D: Found in mushrooms and supplements, Vitamin D is associated with preserved telomere length.
Life-Extending Dietary Patterns
1. Intermittent Fasting (16:8):
Limiting eating to an 8–10 hour window triggers autophagy (cellular “self-eating”), where cells recycle damaged parts to prevent the buildup of “cellular junk” that causes inflammation.
2. Mediterranean Diet:
A diet rich in vegetables and olive oil is a hallmark of “Blue Zones” where residents frequently live past 100.
3. Ribosome Support:
To maintain the cell’s “protein factories,” consume moderate protein (0.8–1g per kg of body weight) and magnesium-rich foods like pumpkin seeds and dark chocolate (70%+ cocoa).
The Summary for Cellular Health
To mitigate cancer risk and promote healthy ageing, one should aim for 7–8 hours of sleep (to support protein synthesis), 30 minutes of daily activity, and 12 minutes of daily meditation for stress management
Consultant Surgical oncologist & Director, Suyog cancer clinics, Thane
Exercises after the surgery
Exercises are required for following reasons:
Avoid deep vein thrombosis
Improves circulation to muscles
Light exercises improve healing and prevent hernias.
Exercises to pelvic floor
Deep breathing exercises helps in lung expansion, better oxygenation and early recovery
Ambulation and exercises makes early return to intestinal motility
Recovery time after the abdominal surgery is approximately one month.
During this time you have to avoid lifting and carrying heavy loads (maximum 1-2kg).
The following measures may be taken:
Sit upright. It may help to sit at the edge of the bed with your feet hanging over the side. If you cannot sit like this, raise the head of your bed as high as you can.
If your surgical cut (incision) is on your chest or belly, you may need to hold a pillow tightly over your incision. This helps with some of the discomfort.
Take a few normal breaths, then take a slow, deep breath in.
Hold your breath for about 2 to 5 seconds.
Gently and slowly breathe out through your mouth. Make an “O” shape with your lips as you blow out, like blowing out birthday candles.
Repeat 10 to 15 times,
Circulation exercises
These help to maintain the blood circulation in your legs whilst you are not so active. This reduces the risk of getting a blood clot (DVT).
• Keep your legs and ankles uncrossed at all times
• With your legs stretched out, briskly circle your feet and bend them up and down.
Do these every hour while you are awake. You can do these when lying down or sitting in a chair
Basic exercises
Start with exercises sat in a chair:
• March your knees alternately for 30 seconds.
• Bend and straighten your knees. Hold your knee straight for 10 seconds, keeping your toes pulled up. Repeat 5 times with each leg as you are able.
Lift your heels and toes alternately for 30 secondsOnce you can do these exercises comfortably, progress to exercises in a standing position. Place your hands on a supportive surface like a kitchen worktop or back of a chair. Make sure your shoulders are not hunched and that you’re standing tall:March for 30 seconds.Push up onto your toes 10 times
After 2 weeks post surgery:
you can start exercises for the internal abdominal muscles. The purpose of this exercise is to regain the function of abdominal muscles and to prevent wound hernia. You should do this exercise 5 – 6 days a week.
Take supine position with knees flexed and arms on your sides. Lift your head during exhale and lay it back during inhale. Repeat exercise at the pace of your normal breathing 3 x 5 – 15 times You can also start light stretching for the abdominal muscles. The purpose of this exercise is to restore the elasticity of the abdominal muscles and prevent tension of scar tissue. Stretches should be done after the abdominal muscle exercise (5 – 6 days a week)..Take supine position with arms on your sides. Lift arms over your head during inhale and move them back to starting position during exhale. Repeat exercise at the pace of your normal breathing 3 x 2 – 5 times.
After 6 weeks of surgery you can start exercises for the external abdominal muscles. The purpose of this exercise is to strengthen your abdominal muscles.
Take supine position with knees flexed and arms crossed over your chest. Arch your upper back during exhale. Your head, shoulders and upper back should rise up from the surface. Relax your muscles and return back to starting position during inhale.
Repeat exercise at the pace of your normal breathing 3 x 5 – 15 times.
Core Stability Exercises
Having major abdominal surgery will affect your abdominal muscles and hence your core stability. To improve your core stability, please do the exercises outlined in the following pages. The best position to do these exercises is lying on the floor. However, if you are unable to do so, you could do them lying on a bed. Aim to do them three times a day.
1. Deep Abdominals
• Lie on your back, knees bent, at hip width apart, feet flat
• Put one pillow under your head
• Breathe in, gently letting your tummy rise
• As you breathe out, gently draw your tummy button towards your spine
• Hold for a few seconds, then relax
• Rest for a few seconds
• Repeat 3-5 times
Remember: • Keep your back still • Don’t hold your breath • Build up gradually – holding your tummy in for a maximum of 10 seconds, repeating it 10 times.
2. Pelvic Tilting
Lie in the same position as shown.
• As you breathe out and draw your tummy in, gently tilt your pelvis and flatten the small of your back into the bed.
• Hold for a few seconds, and then relax
• Repeat 3-5 times and gradually build up to 10 times
3. Knee Rolling
Lie on your back, knees bent and together, feet flat • Draw and hold your tummy in • Slowly lower your knees to one side, making sure that your shoulders remain on the floor • Return to the starting position • Lower your knees to the other side making sure that your shoulders remain on the floor • Keep breathing normally • Repeat 3-5 times and gradually build up to 10 times
Walking & Yoga:
Aim to walk every day gradually increasing the distance. You should aim to be able to walk 30 minutes daily by one to two months after your operation. Start walking on level ground and gradually build up to inclines and uneven ground such as cobble paths. Walking on uneven surfaces requires small changes of direction which can cause some discomfort in the healing abdominal muscles. After two to three months you could consider moderate exercise like swimming or cycling. To progress your core stability exercises you could attend a Yoga or Pilates group. However, seek advice from the group’s instructor about an appropriate level of exercise. If you wish to return to a specific sporting activity please discuss this with your consultant.
You can return to your previous activities after 1 – 2 months.
Cancer is a disease due to change in our genetic material. Hence such cells are characterized by unrestricted growth of cells that is independent of need, body signals and lack the cell mortality unlike normal cells. so such ever proliferation immortal sort of cells produce a big toll on our body as they consume lots of nourishment instead of other normal vital tissues. Hence cancer is a dangerous disease.
Cancer incidence in our country is on tremendous rise and soon it will be No1 disease as far as total number of affected population and the death toll too. Thus a lot of efforts need to be put in control and more importantly prevention of such disease. Following are the simple measures that can significantly reduce cancer risk.
AVOID TOBACCO:
Tobacco in any form is dangerous and can cause cancers in multiple organs. It is the single largest and preventable cause for cancer. It accounts for almost 40 % of total cancer burden in India. Despite the media publicity and warning signs on cigarette packs and tobacco pouches, the consumption of these products hasn’t yet ceased. Hence a stringent public awareness and deaddiction programs are a must and be made available at multiple accessible places.
HEALTHY DIET:
Diet has a great role in normal growth of an individual. However with the changing trends in food, food habits, food storages, fast food, pesticides, genetically modified animals and plants used in food have greatly increased the risk of cancers.
one need to consume 1/4 portion of diet as raw fruits and vegetables. They provide good antioxidants and vitamins apart from the loads of fiber contents. The vitamins and antioxidants aid in neutralizing the cancer causing agents and fibers in diet reduce the contact period with gut and aids in excretion of harmful substances.
NO ALCOHOL:
Alcohol has become a status symbol for many and habit or addiction for the rest consumers. However both the subset of people do not understand the gravity of issues like cancer which are invited with each peg of liquor. Alcohol is itself harmful for oral cavity, esophagus, stomach, gut, liver and pancreas.
It also increases the solubility of other cancer causing agents and help in their absorption in blood. So its role is not additive but multiplicative in cancer causation. Alcohol habit can only be prevented by public awareness and deaddiction facilities.
EXERCISE:
Daily moderate exercise helps in maintain circulation, muscle activity, good lung and heart compliances. It as well utilizes the stored excess fats and sugars in body and thus keeps the weight under control. Obesity contributes to 15% of cancer load. Exercise is an effective method to keep it under control.
BREAST FEEDING:
The risk of breast cancer is less in the ladies who have breast fed the kids at least for first 6 months. It is a protective factor hence need to be advocated among the young mothers.
VACCINES:
Human papilloma virus causes cervical, anal or perianal cancers, oral and pharyngeal cancers. Thus vaccine against HPV is postulated to prevent these cancers. the two dosages are to be administered to young teens ie 9-12 years ideally and maximum up to 26 years, more importantly to the ladies not exposed to sexual intercourse.
Hepatitis B is also a preventable cause for liver cancer. The vaccine against HBV is effective and time tested.
CANCER SCREENINGHK:
Screening is evaluation of apparently asymptomatic population to find out disease under evaluation. the effective screening detects many early cancers that are curable. Screening may detect pre cancerous conditions or high risk individuals that can be treated in time to prevent cancers completely.
AVOID TOO MUCH SUNLIGHT:
though sunlight is essential source of vit D, excess of it may expose one to the harmful U V rays. UV rays are known to produce skin cancers like Basal cell carcinoma etc. Use of sunscreens and avoiding long exposure to sun may prevent skin cancers
Lymphedema occurs when the lymph system is damaged or blocked. Fluid builds up in soft body tissues and causes swelling. It is a common problem that may be caused by cancer and cancer treatment. Post therapy, patients may have swelling in the upper limb. It may be perceived as increased girth of upper extremity, heaviness, skin changes in form of fine pitting at hair follicles etc.
Causes of lymphedema:
Due to extensive axillary dissection→ disruption of lymphatics
Heavy cancer cell budon blocks the lymph nodes and main lymphatic channels
Radiation creates fibrosis and destruction of lymphatic pathways.
Precautions:
Keep skin and nails clean and cared for, to prevent infection. Bacteria can enter the body through a cut, scratch, insect bite, or other skin injury. Fluid that is trapped in body tissues by lymphedema makes it easy for bacteria to grow and cause infection. Look for signs of infection, such as redness, pain, swelling, heat, fever, or red streaks below the surface of the skin. Call your doctor right away if any of these signs appear. Careful skin and nail care helps prevent infection:
Use cream or lotion to keep the skin moist.
Treat small cuts or breaks in the skin with an antibacterial ointment.
Avoid needle sticks of any type into the limb (arm or leg) with lymphedema. This includes shots or blood tests.
Use a thimble for sewing.
Avoid testing bath or cooking water using the limb with lymphedema. There may be less feeling (touch, temperature, pain) in the affected arm or leg, and skin might burn in water that is too hot.
Wear gloves when gardening and cooking.
Wear sunscreen and shoes when outdoors.
Avoid blocking the flow of fluids through the body.
Do not carry handbags on the arm with lymphedema.
Do not use a blood pressure cuff on the arm with lymphedema.
Do not use elastic bandages or stockings with tight bands.
Keep blood from pooling in the affected limb.
Keep the limb with lymphedema raised higher than the heart when possible.
Do not swing the limb quickly in circles or let the limb hang down. This makes blood and fluid collect in the lower part of the arm or leg.
Do not apply heat to the limb.
Studies have shown that carefully controlled exercise is safe for patients with lymphedema. is important to keep body fluids moving, especially through an affected limb or in areas where lymphedema may develop.
Do not cross legs while sitting.
Change sitting position at least every 30 minutes.
Wear only loose jewellary and clothes without tight bands or elastic.
The goal of treatment is to control the swelling and other problems caused by lymphedema.
Treatment of lymphedema may include the following:
Pressure garments
Exercise
Bandages
Skin care
Damage to the lymph system cannot be repaired. Treatment is given to control the swelling caused by lymphedema and keep other problems from developing or getting worse. Physical (non-drug) therapies are the standard treatment. Treatment may be a combination of several of the physical methods.
Treatment of lymphedema may include the following:
Exercise Both light exercise and aerobic exercise (physical activity that causes the heart and lungs to work harder) help the lymph vessels move lymph out of the affected limb and decrease swelling. Breast cancer survivors should begin with light upper-body exercise and increase it slowly. Some studies with breast cancer survivors show that upper-body exercise is safe in women who have lymphedema or who are at risk for lymphedema. Weight-lifting that is slowly increased may keep lymphedema from getting worse. Exercise should start at a very low level, increase slowly over time. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly.
Pressure garments
Pressure garments are made of fabric that puts a controlled amount of pressure on different parts of the upper limb to help move fluid and keep it from building up. Some patients may need to have these garments custom-made for a correct fit. Wearing a pressure garment during exercise may help prevent more swelling in an affected limb. It is important to use pressure garments during air travel, because lymphedema can become worse at high altitudes. Pressure garments are also called compression sleeves and lymphedema sleeves or stockings. Once the lymph fluid is moved out of a swollen limb, bandaging (wrapping) can help prevent the area from refilling with fluid. Bandages also increase the ability of the lymph vessels to move lymph along. Lymphedema that has not improved with other treatments is sometimes helped with bandaging.
Skin care The goal of skin care is to prevent infection and to keep skin from drying and cracking. See skin care tips, in the Managing Lymphedema section.
Compression device: lymphapress Compression devices are pumps connected to a sleeve that wraps around the arm or leg and applies pressure on and off in a sequential and graded manner ie more distally and less proximally. The sleeve is inflated and deflated on a timed cycle. This pumping action may help move fluid through lymph vessels and veins and keep fluid from building up in the arm or leg. The use of these devices should be supervised by a trained professional because too much pressure can damage lymph vessels near the surface of the skin.
Understand about the types of breast cancer surgeries:
Lumpectomy: Your tumour (lump) and a small amount of normal breast tissue around the tumour was removed.
Mastectomy: Your whole breast was removed.
Axillary lymph node dissection: Most (lower two thirds) of the lymph nodes under your arm were removed to:1]check if the cancer spread from your breast to the lymph nodes under your arm 2]remove any cancer that may have spread to your lymph nodes. This reduces the risk of cancer coming back in armpit.
Radical or modified radical mastectomy [RM/MRM]: this involves radical removal of breast with tumor in toto and axillary dissection as described above. In this surgery the contour and substance of the breast is lost. For reconstruction after such surgery one may choose doing skin sparing mastectomy [SSM] with reconstruction using flaps or prosthetic material or both.
Breast conservation surgery[BCS]: this involved wide lumpectomy or removal of palpable mass in breast with certain amount of adjacent breast tissue and leaves behind the rest of breast. It also involves axillary dissection which means removal of lymph nodes along with fibrofatty tissues from armpit [where this cancer can spread or could have spread]. This may be followed by refashioning breast tissue for better form and shape to breast which is called oncoplasty. The reconstruction may as well involve usage of tissue from outside breasts like LD flap or prosthetic material like implants. Radiation to the remaining or conserved breast is a must after breast conservation surgery.
Sentinel lymph node biopsy: This helps find out whether breast cancer has spread to lymph nodes under your arm. The sentinel nodes may be the first lymph nodes your tumour drains into. If the sentinel nodes have cancer cells, then more lymph nodes may need to be removed. And if sentinel node is negative on intraop frozen section assessment, further axillary dissection may not be warranted.
The best suitable surgery for any patient revolves around following factors:
Tumour size and location
Tumor to breast size ratio
Patient’s desire for conservation or radical removal of breast
Age, comorbidities, willingness and feasibility of radiation etc
Liver cancer is long known entity to the human race and the research into it has led to better understanding and evolution of surgical sciences. The newer treatment modalities have yielded better longevity and quality of life. Liver tumours are usually asymptomatic till they obstruct biliary excretion passage i.e. bile duct or destroy significant liver parenchyma to cause jaundice. Such jaundiced patients usually have severe itching, yellowing of eyes and high colour urine. Due to less to no bile secretion in intestines the patients get clay colour stools. As the tumours grow, patients get pain, nausea, anorexia and ultimately weight loss.
Simple liver function tests and tumour markers like AFP, CA 19-9 along with imaging modalities like CT/ MRI scan can pick up liver cancers. But a Biopsy is a must for confirmation. It can be done with needle under USG or CT scan guide.
The treatment is surgery for initial stages and combination of other adjunct modalities with surgery like TACE i.e. trans arterial chemoembolization, TARE i.e. trans arterial radioembolization etc. For the tumours that are disseminated or inoperable, targeted therapy or chemotherapy are given.
the prognosis depends on the initial stage at presentation and liver function. Hence the most important is to pick up the lesions at early stage.
Most cases of cervical cancer are found in women younger than 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. About 20% of cervical cancers are found in women older than 65. These cancers, however, rarely occur in women who have been getting regular tests for cervical cancer before they were 65. Even in 21st century, cervical cancer remains in one among the top affecting Indian women.
Genesis of cervical cancer:
Most cervical cancers begin in the cells in the transformation zone i.e. endo and ecto cervix. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing.
Types of cervical cancer
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.
Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers develop from cells in the ectocervix and the cancer cells have features of squamous cells under the microscope. Squamous cell carcinomas most often begin in the transformation zone (where the ectocervix joins the endocervix).
Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the past 20 to 30 years.
Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body.
Risk factors:
Human papilloma virus (HPV) infection
Infection by the human papilloma virus (HPV) is the most important risk factor for cervical cancer. HPV is a group of more than 150 related viruses. Some of them cause a type of growth called papilloma, which are more commonly known as warts.
• HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
• HPV can spread from one person to another during skin-to-skin contact. One-way HPV spreads is through sex, including vaginal, anal, and even oral sex.
• Different types of HPV cause warts on different parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue. Certain types of HPV may cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types of HPV because they are seldom linked to cancer. Other types of HPV are called high-risk types because they are strongly linked to cancers, including cancer of the cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women. It is believed that a woman must be infected with HPV in order to develop cervical cancer. Although this can mean infection with any of the high-risk types, about two-thirds of all. Cervical cancers are caused by HPV 16 and 18. Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer. Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes.
Smoking
When someone smokes, they and those around them are exposed to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body. Women who smoke are about twice as likely as non-smokers to get cervical cancer. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections.
Immunosuppression
Human immunodeficiency virus (HIV), the virus that causes AIDS, damages a woman’s immune system and puts them at higher risk for HPV infections. This might explain why women with AIDS have a higher risk for cervical cancer. The immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it normally would. Another group of women at risk for cervical cancer are those taking drugs to suppress their immune response, such as those being treated for an autoimmune disease (in which the immune system sees the body’s own tissues as foreign and attacks them, as it would a germ) or those who have had an organ transplant.
Chlamydia infection
Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility. Some studies have seen a higher risk of cervical cancer in women whose blood tests and cervical mucus showed evidence of past or current chlamydia infection. Women who are infected with chlamydia often have no symptoms. In fact, they may not know that they are infected at all unless they are tested for chlamydia during a pelvic exam.
A diet low in fruits and vegetables
Women whose diets don’t include enough fruits and vegetables may be at increased risk for cervical cancer.
Being overweight
Overweight women are more likely to develop adenocarcinoma of the cervix.
Long-term use of oral contraceptives (birth control pills)
There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped, and returns to normal about 10 years after stopping.
Intrauterine device use
Some research suggests that women who had ever used an intrauterine device (IUD) had a lower risk of cervical cancer. The effect on risk was seen even in women who had an IUD for less than a year, and the protective effect remained after the IUDs were removed. Using an IUD might also lower the risk of endometrial (uterine) cancer. However, IUDs do have some risks. A woman interested in using an IUD should first discuss the possible risks and benefits with her doctor. Also, a woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.
Having multiple full-term pregnancies
Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. One theory is that these women had to have had unprotected intercourse to get pregnant, so they may have had more exposure to HPV. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that pregnant women might have weaker immune systems, allowing for HPV infection and cancer growth.
Being younger than 17 at your first full-term pregnancy
Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.
Economic status
Many low-income women do not have easy access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers.
Diethylstilbestrol (DES)
DES is a hormonal drug that was given to some women between 1940 and 1971 to prevent miscarriage. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. These types of cancer are extremely rare in women who haven’t been exposed to DES. There is about 1 case of vaginal or cervical clear-cell adenocarcinoma in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of “DES daughters” do
not develop these cancers. DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 40 − past the age of highest risk. Still, there is no age cut-off when these women are felt to be safe from DES-related cancer. DES daughters may also be at increased risk of developing squamous cell cancers and precancers of the cervix linked to HPV.
Having a family history of cervical cancer
Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are 2 to 3 times higher than if no one in the family had it. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women in the same family as a patient already diagnosed could be more likely to have one or more of the other non-genetic risk factors previously described in this section.
Breast cancer is most rapidly increasing in number in Indian females too as the western world. one in 8 females is diagnosed with breast cancer in USA. Unfortunately, exact Indian data is unavailable. however the key to combat with this dangerous disease is early detection and correct treatment for diseased and prevention for the remaining healthy.
Following are the strategies to prevent and early detection of breast cancer:
1] self-breast examination.
2] yearly mammography and clinical breast examination
3] know your genetic and family history of cancers
4] avoid obesity.
5] regular exercise
6 ]avoid alcohol, hormone replacement therapies and OC pills.
7] avoid late pregnancy
8] breast feeding is protective against breast cancer
