Cancer in Women

Certain cancers are of specific concern to women. One area of interest are cancers of the female reproductive organs – breast, cervix, uterus and the ovary.

1. Age- the incidence of this cancer increases with age.
2. Genes- 2 genes, BRCA-1 and BRCA-2 occurrence greatly increases the risk. Women with familial history of breast and ovarian cancer may wish to be tested for these genes and take the appropriate action.
3. Personal history factors- onset of menses before age 12, and a menopause after age 55. Other risk factors are drinking excessive amounts of alcohol, being overweight, not having children until after age 35, hormonal replacement and dense breasts.

Research studies have shown that the earlier the detection of the cancer the greater the rate of cure and survival. For women with the normal risk of breast cancer, self-examination, clinical exams (by a health professional), and mammography starting at age 40 are the standards. Abnormal results or an individual with high risks may need earlier and additional screening tests.

Breast Self-Examination
This should be performed by the women on a regular basis (immediately after a menses). Any questionable findings should be discussed with one’s physician.

Clinical Breast Examination
This should be part of a women’s yearly examination, starting at puberty and continuing through the women’s life.

Mammography
Is a type of x-ray study, which is performed on a yearly basis from age 40 on. Women with risks, such as familial incidence of breast cancer, should begin this screening at an earlier age (as ordered by her physician). Mammography is the “gold standard” for breast cancer screening.

Breast Ultrasound
Physicians may use breast ultrasound images to determine whether a breast mass is cystic (fluid filled and probably not malignant) or solid (higher suspicion).

Breast MRI
This relatively new tool is very helpful in evaluating the very dense, cystic breasts seen in young women. This new type of study may someday be the new standard for breast screening.

The importance of routine breast exams (both clinical and radiological), is to find a malignancy at its earliest possible moment – hence, increasing the cure and survival rate in a woman.

Ovarian Cancer
This is a malignancy that arises in the ovaries of a woman. The ovaries are walnut sized organs located adjacent to the uterus. It is the female organ that produces the female hormones (estrogen and progesterone) and the eggs needed for procreation.

Ovarian cancer is less common than breast cancer. It occurs in 1 in every 70 women in the U.S. Ovarian cancer has a high death rate, because it is most often found late, when the disease is in an advanced stage and more difficult to treat – “silent killer”. There are no good or standard screening tests for ovarian cancer. Pelvic sonogram and a Ca 125, done in the postmenopausal woman, are of limited value. Women should have a thorough pelvic exam with their yearly physicals, to detect ovarian pathology. In addition, women who complain of the following symptoms should be seen by their gynecologist: persistent bloating, pelvic or abdominal pain (with or without intercourse), nausea, and the need to urinate frequently.

Cervical Cancer
This is a malignancy of the cervix (the lower part of the uterus). 11,000 women will be diagnosed with this disease yearly in the U.S. Because of effective screening (the yearly Pap smear) we can detect cervical precancerous and cancerous lesions early and most women can be cured of this disease.

There are multiple factors which may lead to this disease:

1. Smoking
2. Age- the incidence increases with age
3. Human papilloma virus (HPV) - this virus (wart producing virus) is the most significant factor in the production of this disease. Over 99% of women who have cervical cancer have HPV, which is was contracted through intercourse.

Cervical cancer may be readily screened for with the cost-effective Pap Smear. This test should be performed on all women, 3-5 years after their first sexual intercourse. If the Pap Smear demonstrates cellular abnormalities, or the presence of HPV, then further investigations are required. A colposcopy (the examination of the cervix using a lighted magnifying instrument) and a biopsy will confirm the presence of this precancerous or cancerous process. Once a diagnosis is made, the appropriate therapy may begin.

An immunization against HPV has been developed and is being used in both young women (age 10-12) and young men. By immunizing these individuals we hopefully can lower the incidence of cervical cancer, which is contracted via sexual contact.

Uterine Cancer
In 2009, an estimated 42,000 women ion the U.S. will be diagnosed with uterine Cancer (7,800 will die of the disease). In most cases, this cancer begins in the lining cells of the uterine cavity (endometrial cancers). A very small number of cases begin in the muscle cells of the uterus and are called sarcomas.

The signs and symptoms of this cancer are: abnormal menstrual bleeding from the vagina, feeling of lower abdominal or pelvic fullness, and frequent urination. If any of these occur, then a tissue diagnosis is to be made by obtaining samples of endometrial cells from the uterine lining. These cells are removed from the uterine cavity during an endometrial biopsy (a small aspirator is placed into the uterus) or by dilatation and curettage (D&C). A D&C is a surgical procedure to remove samples of endometrial cells from various areas within the uterine cavity. Pathological studies of this tissue will then be performed and a diagnosis made. Treatment may then be started.

Summary
Women have several malignancies which are specific for their reproductive organs (breasts, ovaries, uterus and cervix). These have been discussed in the above article. Cancer of the lungs (increased because women are smoking in greater numbers) and of the colorectal area, are also of great importance and women should see their physicians about these diseases.