CARING FOR THE CARERS – GYNECOLOGICAL MALIGNANCIES OF OLDER WOMEN

It is estimated that roughly three quarters of cancer deaths occur in women in Zambia. Cervical cancer, of course, accounts for a large proportion of these cases but there are other types too. Gynaecological cancers are cancers that occur in the women’s reproductive tract i.e. starting from the outside vulva, vagina, cervix, uterus fallopian tubes and lastly the ovaries.

Much attention and rightfully so is given to the cancer of the cervix. This week I would like to focus on two cancers, space permitting, that do not receive much of the spotlight ovarian and endometrial but affect our older women.

Ovarian cancer is known as the silent killer. I shall therefore destroy its attacking mechanism and break the silence! Empower you with knowledge that will allow you to possibly identify this cancer early. Why is ovarian cancer known as the silent killer? The answer lies in the fact that where as most cancers will start giving signs and symptoms sooner rather than later, ovarian cancer can grow to great proportions before being detected.

The ovaries are the organs in a woman that produce eggs for fertilisation to make children. They themselves are egg shaped and sit on the side of the womb. After puberty (11-13 years in most girls) they present an egg for fertilisation each month, sometimes alternating between themselves, till the female reaches a stage in her life called menopause (it starts around the age of 45 – 55 in most women) when she stops menstruating.

Incidentally it is around the later time that one type of ovarian cancer called the epithelial ovarian cancer peaks in its occurrence in women. One of my readers last week wrote me an email and reminded me how scary the whole cancer topic is to most. These complicated medical terms do not help. Bear with me I will explain each term as we go along.

As a deviation from topic one of the reasons I started writing this column was to empower Zambians with robust knowledge of cancers. Not just the surface common myths and busters but to actually develop a database of knowledge where you my readers can better understand where these things come from and why. Admittedly, it can be like a biology lesson at times but its only once a week. You will be amazed at how when one is knowledgeable about something they are not afraid of it. Think deeply on this and smile – its good for your soul. Don’t be scared to add a couple of complicated terms to your vocabulary. I am challenging you! Remember even at church we graduate from Sunday school to adult church, so for cancer knowledge I need to take you from baby class to big class but I promise to hold your hands!

Back to the topic at hand – ovarian cancer. As mentioned there are two categories epithelial, which develops from the lining and germ cell, which develop from the substance of the gland. The epithelial type occurs in older women where as the germ cell type is more common in young females. I will not touch on germ cells today.

Unfortunately there is no good screening test for ovarian cancer before the symptoms are overt. This is why it is known as the silent killer. The most common symptoms are weight loss, getting full easily when eating and feeling bloated all the time. Now as you can see this is truly non-specific. How many women into their years of menopause and hot flashes would not be glad to lose some weight? Some take it as a positive occurrence till it gets way out of hand. Feeling bloated as well, commonly known as gases, is something women start suffering from early in their lives. The symptom that usually raises the alarm is when the abdomen or tummy starts looking big due to an accumulation of fluid in the abdomen called ascites.

The good news is ovarian cancer is highly treatable in the hands of a good surgeon and chemotherapist. The idea behind surgery is to remove any visible cancer present in the abdomen. The principle behind chemotherapy is to mop up the small cancers that we cannot see with the naked eye which ovarian cancer is notorious for leaving. Sometimes the cancer is too stuck to normal organs for the surgeon to remove and the operation is performed in between two courses of chemotherapy. The first to shrink the disease and the second is to mop up what is left. This is called sandwich treatment. At this point, we can monitor the cancer sometimes with a test called CA 125.

The second cancer I want to draw attention to is endometrial cancer. The endometrium is the lining of the womb and is responsible the monthly period that females see. However, I know you are experts now, around menopause (refer to earlier) this monthly shedding stops at a certain age. For some women instead of these cells resting they become cancerous. Again a robust screening test is not in use for this cancer.

I will pause to explain absence of screening tests in this important cadre of the population. Even though cancer is serious and we want to catch it before it even breathes its first breath the benefit of an intervention to look for something must outweigh the risk. There is what we call false positives and these can actually be harmful for individuals. That is why whole body scans to look for cancer are not a ‘thing’ but it’s done anyway in certain regions. So for older women who may have other health issues that can be more life threatening than cancer and actually can preclude their ability to undergo the heavy treatment associated with this, screening may not be an option. This may be a little hard to digest but take it and keep it we will have another article specifically on this nuance.

However, recently a big study was published establishing overwhelming benefit that if a woman has reached menopause and starts seeing bleeding from her vagina, investigation of this bleeding by taking a biopsy of the lining of the womb may save her life. This biopsy procedure (taking a small piece of ‘meat’ to look at under a microscope) sounds scary but in actual fact is referred to as a doctor’s room appointment. This means there is no need to go to theatre for an elaborate procedure but you walk into a doctor’s daytime office like you would for an antenatal visit.

Surgery is also the cornerstone of treatment for this cancer, but sometimes we need to supplement it with chemotherapy and radiation.

The types of cancer discussed affect our very important women in society. Usually these ladies don’t want to bother anyone with their symptoms and by the time you force it out of them it may be too late to save a life. Be cancer aware and keep our grannies alive. We need them.

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