Signs of Cervical Cancer

Dr. Th. Tomcha
January 18, 2021

Cervical cancer, also known as Womb Cancer, is the fourth most common cancer in females worldwide and the third most common in both India and Manipur. Approximately 1 lake new cases are diagnosed worldwide every year. Luckily, the disorder is on the decline. A decade back, it happened to be the most common female cancer in both India and Manipur. It is one of the leading causes of death in women.

Risk Factors: Exposure to these increases the chances of developing the disease.

•    Human Papilloma Virus (HPV): It has the highest risk factor associated with more than 90% of cervical cancer. The most common HPV variants associated with cervical cancer are HPV 16 & 18. The presence of the virus to the husbands also exposes their wives equally.
•    Early Marriage: Early marriage before 18 years increases the chances of developing the disease. If sex life is started before 16 years, the increase is very significant.
•    Multiparity: There is exponential increase in risk factor with more childbirths (more than 2).
•    Multiple Sexual Partners: Having sexual relations with multiple partners increases the risk factor.
•    Smoking: Increases the chances of developing the disease.
•    Hygiene: Hygiene of private parts of both husband and wife is related with the disease
•    HIV: As HIV positive women has a low immunity, they have higher chances of developing cervical cancer.
•    Mothers who took hormone replacement therapy like Diethylstilbestrol increases the incidence of the disease in their daughters.
•    Low and Middle Income group: 90% of cervical cancer develops in this group. This is because of lack of micronutrients in their diet and private bathrooms thereby compromising with personal hygiene.

Presenting Symptoms: 
•    Bleeding after Intercourse: This is the first symptom of cervical cancer and must be regarded as a warning sign.
•    Vaginal Discharge (May or may not be foul smelling): This is the commonest symptom.
•    Bleeding per Vagina: Unusual bleeding like in post-menopausal ladies (When menstruation has been stopped) and bleeding in between menses in pre- menopausal ladies are suspicious symptoms of the disease.
•    Pain Lower Abdomen: Due to the tumour mass effect, there may be pain in lower abdomen. This pain may be referred to the back and later to upper thigh even.
•    Constipation: The tumour mass may cause compression of rectum and cause constipation.
•    Constitutional Symptoms: Weakness, loss of appetite, pallor, fever, loss of weight, body ache etc. may be present.
•    Systemic Symptoms: When the disease has spread to different parts (Systems) of the body, it can lead to all types of symptoms related to the system where disease has spread.

Management: Cervical cancer is regarded as a mostly preventable disease and when possible, it is the best approach. The adage “Prevention is better than cure” holds equally true in this disease. Next to prevention, early detection is of utmost importance. Once detected early, the disease is mostly curable.

Prevention: 
•    Avoidance of the risk factors stated above will eliminate the disease from appearing to a great extent.
•    Routine Pap Smear and DNA testing for HPV 16, 18: By these tests, we can detect in the pre-cancer stage. Luckily in cervical cancer, we get a buffer time of 10-15 years to become cancerous from pre-cancer stage. By instituting proper treatment during this period, we can prevent from developing frank cancer disease. 
•    HPV Vaccination: As more than 90% of cervical cancers are caused by HPV, eliminating this virus from the body by preventive HPV vaccination, we can prevent cervical cancer to a great extent. The recommended time of having the vaccine is 9-14 years before sex life starts. It is not useful if dine beyond 26 years.
Early Detection:
Next to prevention, early detection is the 2nd best strategy. When detected early (Stage I, II), more than 60% cervical cancers can be cured.
•    Being alert to warning signals and promptly reporting to concerned doctors.
•    By having timely Pap Smears. Present recommendation (National Cancer Institute and American College of Gynaecologists) is:
o    Start Pap smear by age 21
o    From 21-29 years of age, have it every 3 years
o    Starting at age 30, Pap smear and HPV DNA test must be done every 5 years till 65.
o    Women above age 65, who had regular screening over last 10 years with consistently normal results may consider stopping screening.

•    Visual Inspection with Acetic acid and Lugol’s Iodine. This is to be done by doctors or trained nurses.
•    Annual pelvic examination by doctors

Treatment:
Once the diagnosis has been confirmed and the necessary investigations and staging have been completed, treatment should be started as early as possible. Surgery and radiation treatment are curative forms of treatment with equal efficacy. The role of chemotherapy is adjunct to surgery or radiation or palliative therapy.
•    Surgery: The applicability of surgery is limited and is confined only in the early stages (Stage I, IA).
•    Radiation Treatment: It is applicable in all stages (I-IV). In advanced stages, a combined treatment with chemotherapy gives better results.
•    Chemotherapy: It is used as an adjuvant to surgery or radiation to enhance beneficial effects. Standalone, it is not curative in cervical cancer. It is also used as palliative treatment (Symptom relieving).

 

Dr. Th. Tomcha is a Sr. Consultant, Radiation Oncology at American Oncology Institute at Babina Speciality Hospital, Imphal

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Dr Parinitha Gutha
February 15,2021

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Children’s Cancers are rare compared to those in adults.

Worldwide, around 3 lakh children and adolescents are diagnosed with cancer every year and 80% of them live in developing countries.

As infectious diseases are becoming more controlled in children, cancer is emerging to be the leading cause of death after accidental deaths. 

The good news is that most of the children’s cancers are now curable, but many factors are acting against achieving this result. Because they have their uniqueness, both biologically and psychologically, they must be treated in dedicated Pediatric Cancer Units to achieve results.

Types of Childhood Cancers

More than a dozen kinds of childhood cancers and a hundred different subtypes exist. 

Blood cancers, brain cancers, and neuroblastomas account for more than half of the cancers in children.

The most common childhood cancer is Acute Lymphoblastic Leukemia (ALL). In the 1950s, almost every child with ALL died. But today, about 90% of children with ALL survive.

Causes

The cause is usually unknown and not linked to any environmental or genetic factors apart from a small proportion (5%) which is caused by an inherited genetic condition.

In adults, the mutations reflect the cumulative effects of aging, long-term exposure to cancer-causing agents. However, it has been difficult to identify potential environmental causes of childhood cancer.

The analogy is that most cancers develop as a result of mutations in genes that lead to uncontrolled cell growth.

Treatment

It is important to know that Children's cancers are not always treated like adult cancers.

Children should not only survive, but thrive. To achieve this, Cancer needs to be diagnosed early and treated in dedicated Paediatric Oncology Units where the team is focused and qualified to respond to children's needs. Many individuals are not aware that this expertise exists and that many childhood cancers are handled successfully.

The types of treatment that a child with cancer receives will depend on the type of cancer and how advanced it is. Common treatments include chemotherapy, surgery, radiation, immunotherapy, and bone marrow transplantation.

What is the outlook?

Most childhood cancers are highly curable, provided prompt and effective treatment is accessible. 

In resource-rich countries, three out of four children survive (about 80%).

The Survival gap…

Unfortunately, this is not the case in India. Around 80% of children with cancer live in developing countries and more than half die. There are no cancer registries to give us accurate statistics, children are often not diagnosed, or diagnosed too late, and limited access to information and life-saving treatment. 

However, the situation is becoming more hopeful with the availability of dedicated Paediatric cancer Units providing excellent standards of care.

Children’s Cancers are curable and they are no less important than children fighting malaria, dengue, malnutrition, and other causes of death.

Let us stand up to cancer and strive to save our children!

 

Dr Parinitha Gutha is a Senior Consultant, Paediatric Oncology/Hematology at American Oncology Institute, Hyderabad

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Agencies
February 27,2021

Corona Vaccine Update : NITI Aayog propose vax price between Rs 300-500 -  Trusted Online News Portals In India | Breaking News India

New Delhi, Feb 27: The NITI Aayog has promulgated a price range of Rs 300-500 for two Covid vaccines that would be available for the priority group at private facilities in the third phase of vaccination set to begin from March 1, sources privy to the development told agencies, adding that the Bharat Biotech's Covaxin would cost a bit higher.

However, the union health ministry would take a final call on the proposition.

The proposed price has been floated after a five-hour long meeting held between the Dr VK Paul, member (health), NITI Aayog and officials from Serum Institute of India and Bharat Biotech on Friday evening, which was concluded around 11 p.m., sources added.

"This would be the price end-user would pay for a dose. It includes the service charge the private facilities can take from the beneficiaries," a top official said.

IANS had reported earlier that private facilities will be able to collect a "service charge" of up to Rs 100 from the beneficiaries to meet the operational expenses they will be incurring during the vaccination drive against Covid-19. This will be in addition to the cost of the vaccines.

As per reports, the government has been procuring SII's Covishield for around Rs 210 per dose while the cost of Covaxin is around Rs 290 for a shot.

The third phase of vaccination will begin from March 1 and will cover 27 crore people above 60 years of age and those above 45 years of age with comorbidities at 10,000 government and over 20,000 private vaccination centres.

The government has decided that the people will be vaccinated free of cost at the government hospitals, while those taking the shots at private hospitals will have to pay.

The vaccines will be stored at public health facilities having cold chain points. The private facilities will be able to receive the desired doses from public hospitals in their vicinity.

Akin to the previous priority groups, healthcare and frontline workers, the general public as well will not be given a choice among the two vaccines. However, the people can make a choice between the centres where they are willing to take the jab, officials told IANS.

"One would not be allowed to choose among the two vaccines. However, they can indirectly go for their preference by selecting the centre they wish to be inoculated since the information of centres along with the vaccines they use will be available to the public," the official informed.

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Agencies
February 20,2021

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Screen time affects boys and girls differently, a new study suggests that boys who play video games regularly are less likely to develop depressive symptoms whereas girls who stay active on social media platforms may experience an increased risk of depressive symptoms.

The findings indicate that boys, who played video games at age of 11 had 24 per cent fewer depressive symptoms three years later, whereas girls who used social media most on days at age 11 had 13 per cent more depressive symptoms three years later.

"Screens allow us to engage in a wide range of activities. Guidelines and recommendations about screen time should be based on our understanding of how these different activities might influence mental health and whether that influence is meaningful," said researcher Aaron Kandola from the University College London.

"While we cannot confirm whether playing video games actually improves mental health, it didn't appear harmful in our study and may have some benefits. Particularly during the pandemic, video games have been an important social platform for young people," Kandola added.

For the study, published in the journal Psychological Medicine, the team reviewed data from 11,341 adolescents who are part of a cohort study to investigate screen time as it is responsible for much of sedentary behaviour in adolescents.

The study participants had all answered questions about their time spent on social media, playing video games, or using the Internet, at age 11, and also answered questions about depressive symptoms, such as low mood, loss of pleasure and poor concentration, at age 14.

The team said that the effect of reduced depressive symptoms was only significant among boys with low physical activity levels. They suggest that less active boys could derive more enjoyment and social interaction from video games.

Other studies have previously found similar trends and researchers have suggested that frequent social media use could increase feelings of social isolation.

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