Lowest Possible Cost of Endometrial Cancer Treatment In India
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Transcript of Lowest Possible Cost of Endometrial Cancer Treatment In India
Endometrial Cancer - There are many causes for post-menopausal
bleeding, but it is most likely an indicator of endometrial cancer The warning signs
50-year-old Mrs. Rao was surprised when she noticed bleeding from
her vaginal area. Her periods had stopped about 2 years ago. She
had mild spotting on two earlier occasions, which she had assumed
would stop on its own, but when this did not happen she finally
decided to visit her gynaecologist.
Post-menopausal bleeding is a common problem accounting for
about five percent of the OPO attendances to the gynaecologist. Any
bleeding 12 months after menopause at normally expected age is
considered as abnormal. Though there are many causes for post-
menopausal bleeding, it would be safer to assume it to be due to
cancer until proven otherwise.
What is endometrial cancer?
Endometrium is the innermost lining of the uterus (womb).
This lining increases in size when the hormone estrogen in
the body increases, and reduces when the hormone
progesterone increases.
It plays an important role in implantation of the embryo after
fertilization. Endometrial cancer is the most common type
of uterine cancer. It commonly occurs in women between
the ages of 60-70. Endometrial cancer is different from the
more common cervical cancer that arises in the lower
portion of the uterus.
Symptoms of Prostate Cancer
Risk factors for endometrial cancer are quite similar to that of breast cancer. This
includes early menarche, late menopause, use of estrogen replacements, obesity and
infertility.
The Diagnosis
Post-menopausal bleeding is the most common way in which endometrial cancer
presents itself. Premenopausal women who have bleeding between the periods or
extremely long or heavy periods should be suspected of endometrial cancer. Some
other patients may have white or clear vaginal discharge. The more advanced cases
may have pelvic pain. After pelvic examination, most gynaecologists would order for
an abdominal ultrasound. A thickened irregular endometrium on ultrasound increases
the suspicion of endometrial cancer. When the level of suspicion is high, the next step
would be to obtain a biopsy.
•Dilation and curettage (0 & C)
•Endometrial aspiration and biopsy
•Hysteroscopy and biopsy
The material removed is sent to a pathologist who either confirms
or disproves the diagnosis of cancer. Once the diagnosis is
confirmed the next step would be to assess the spread of the
disease, which is done by investigations like CT scan or MRI of the
abdomen
Biopsy is usually done by
1. Cancer which is confined to the uterus would be stage
2. Cancer which has gone on to the lower part of the uterus
called the cervix would be stage II
3. Cancer which has spread outside the uterus but is still within
the pelvic area would be stage III
Depending on the extent of spread, the stage of the disease is determined:
Treatment should be received preferably in a comprehensive cancer centre where
surgery, radiation and chemotherapy facilities are available.
Surgery for endometrial cancer involves removal of the uterus from the abdomen
along with removal of both the ovaries. Removal of the uterus from the vagina is not
acceptable.
Hysterectomy is combined with removal of lymph nodes from the drainage areas.
Following surgery, the removed parts are examined by the pathologist, which helps
in determining the final stage of the disease.
Treatment Plan
In very early cases (stage I) and when the tumour is less aggressive, only surgery is
sufficient but in higher stages (stage II or III) or when the tumour is of an aggressive
variety, radiation is recommended. Radiation is of two types, one that is given
externally under CT scan guidance, a procedure known as teletherapy, and the other,
in which radiation is given internally on the residual portion of the vagina by placing
wires, a procedure known as brachytherapy.
On quite a few occasions when the disease has already spread to the lymphnodes, it
may be necessary to combine radiation with chemotherapy. A few patients may be
in the advanced stage of disease, which has spread to liver, lungs or elsewhere in the
abdomen. In this case the options would be either to give chemotherapy with
limited benefit or to just offer symptomatic treatment without doing anything
specific for the disease. On the whole, for patients like Mrs. Rao and many other
women, maximum benefit of treatment can be given when they identify any
abnormal vaginal bleeding or discharge and seek prompt medical attention for it.
When detected at an early stage and promptly treated, the outcome is excellent and
the patients can lead a normal life.
Treatment Plan
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