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Breast Cancer                           Endometrium Cancer                            Ovarian Cancer

 

Breast Cancer

Breast cancer is a disease resulting from a tumor which is caused by deformation and uncontrolled proliferation of one of the cell groups in breast tissue. Cancerous tissue spreads to the, immediate vicinity at first and then lymph glands around the breast. Cancer spreads to other parts of the body and makes the treatment impossible in patients who do not get diagnosed and treated timely.

The actual reason for breast cancer is not clearly known yet. Two-thirds of women diagnosed with breast cancer suffer this disease though not carrying any known risk factors.

The incidence of breast cancer has more than doubled around the world, over the past 50 years. One in 8 women faces with this disease today while it was seen in one in 20 women in socio-economically developed western countries 50 years ago. In recent years, it continues to rise in our country also as in developed western countries. When the findings of Ministry of Health and Universities are evaluated together, one in 8 women suffers from breast cancer during any period of their lives in Turkey.

Protective factors for breast cancer

  • Avoid carcinogenic substances such as alcohol and smoking, 
  • Have a healthy nutrition and do sports regularly,
  • Try to maintain your ideal weight, 
  • Breastfeed for the first 6 months if you have a baby,
  • Do not be a mother late in your life,
  • Pay attention to using hormone drugs.

What are the symptoms of breast cancer?

  • Lump or hardness in the breast that can be felt by hand,
  • The asymmetry between two breasts which has occurred recently,
  • Inward retraction of the nipple or breast skin,
  • Redness, wound, eczema, crusting, cracking on the breast, 
  • Orange peel appearance on the breast skin, 
  • Change in the shape or direction of the nipple,
  • Unusual swelling or enlargement of the breast,
  • Pain in different character that can be seen in menstruation period, 
  • Nipple discharge, especially in pink or red color, 
  • Hardness, swelling or lump in armpit.

Risk factors for breast cancer

  • Being a woman, 
  • Women in the age range of 50-70 and post-menopause period,
  • Women with close relatives (in maternal or paternal side) who have been diagnosed with breast cancer (The closer the degree of relationship and the more number of relatives with breast cancer, the higher the risk is.)
  • Women having been diagnosed with breast cancer previously, 
  • Women who started menstruating younger and went through menopause period at the late age,
  • Women who have not given birth
  • Women who have given the first birth after the age of 30,
  • Women who have given birth but not breastfed,
  • Women having received hormonal therapy for a long time,
  • Overweight; gaining more weight especially after menopause and consuming much food rich in saturated fat, 
  • Lack of physical activity. 

While these factors increase the likelihood of breast cancer development, most of the women with breast cancer do not carry known risk factors.

Diagnosis methods of breast cancer

Breast self-examination: 

About 70 percent of breast cancers are found when patients examine or analyze their own breasts. For this reason, after the age of 20, women should observe their own breasts at the end of menstruation period preferably in front of the mirror and examine their breasts and armpits by hands. When they notice any change, they should consult a doctor as soon as possible.

Doctor examination: 

Even though they do not have any complaint about breasts, every woman has to undergo an examination from an experienced general surgeon every 3 years between the age of 20-40 and once a year after the age of 40.

Screening methods: 

Breast screening aims to determine breast cancer as early as possible. In parallel with technological developments and widespread use of screening mammography in particular, there is a significant increase in breast cancer cases that can be detected by screening methods even not felt by hand.

Treatment methods of breast cancer

Chance of success in the treatment of breast cancer is directly related to how early-stage cancer is detected. When detected earlier, 5 years of survival rate might rise up to 96 percent.


The most important part of breast cancer treatment is surgical treatment. The purpose of surgery is to remove the entire tumor from the body. Treatment methods other than surgery aim to prevent recurrence of the tumor and spreading to other organs. There are basically 3 surgery types:


Mastectomy: Mastectomy: It means removal of the whole breast with the tumor. In the same session or in a later period (1-2 years later), the new breast can be made for the patient with silicone implants or from her own tissues. 

Skin Sparing Mastectomy: Skin Sparing Mastectomy: This method is preferred in cases where whole breast tissue must be removed but the breast skin can be preserved. Cosmetic appearance is provided by placing silicone implant instead of the extracted tissue. It is particularly preferred for risk-reducing breast surgeries (prophylactic mastectomy). 

Breast-Conserving Surgery: Surgery method based on the removal of the tumor with a portion of the breast tissue around the tumor. This surgery has two goals: First is to preserve the breast in its position and cosmetic appearance is not deteriorated. The second is to ensure that the patient is physically and psychologically affected at the minimal. Radiotherapy is applied for 5-7 weeks after surgery.

Women should see a doctor if they feel any symptom on their breasts.

Even if the result of previous mammograms is normal, women who feel a lump or any other symptom in their breasts need to consult their doctor without wasting time.

Not the whole breast is removed. 

Over the past 20 years, there have been considerable changes in the surgical treatment of early-stage breast cancer. Surveys, involving thousands of patients and follow-up period more than twenty years, have revealed that survival rates provided by breast-conserving surgery method are equivalent to mastectomy (removal of the entire breast). Nowadays, it is not necessary to remove the whole breast in breast cancer surgeries except for some medical emergency situations. Because the breast is an organ that has an important place in women's sexual identities and body perceptions. With these surgical methods called partial mastectomy, lumpectomy and quadranectomy, women do not have to lose their breasts necessarily. However, it might be necessary to remove the whole breast in some patients. In such cases, surgery can be performed for breast repair and surgeons can create a breast that is very similar to the natural breast.

 

Fight like a woman!

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Endometrium Cancer

Endometrium cancer, one of the most common cancer types in women, is a disease that can be detected at early stage. If the treatment starts early, the chance of success becomes high. 

What is endometrium cancer?

Endometrium cancer, one of the most common cancers in women, is known by more than one name. These are; endometrium cancer, uterine cancer, endometrial cancer. Uterus cancer is caused by the cells of the layer covering inner part of the uterine. 

Healthy cells grow, divide and die in an orderly fashion in order to ensure normal functioning of the body. Sometimes, however, cells undergo changes and growth can get out of control. These cells continue to divide even when new cells are not needed. This abnormal division begins to invade neighboring tissues and therefore destroys them. These cells spread to other parts of the body and continue their proliferation. There is a similar development in endometrial cancers. Cancer cells develop in the layer which is the inner part of the uterus. Then they begin the progress towards the other parts of the body. It is not known exactly why these cancer cells develop. However, estrogen hormone is thought to have a place in the development of endometrium cancer. It is also known that research continues on gene changes that develop cancer in endometrial cells.

Prevention methods of endometrium cancer

  • Avoiding from carcinogenic substances such as alcohol and smoking,
  • Using contraceptive pills as they are known to reduce the risk of cancer, 
  • Having smear tests on a regular basis, 

What are the symptoms of endometrium cancer?

Most of the endometrium cancers develop in postmenopausal women in the period when menstruation terminates. Such findings and symptoms as any postmenopausal bleeding, menstrual bleeding or prolonged menstrual period, abnormal non-bleeding discharge, pelvic pain, pain during sexual intercourse and weight loss might be seen in endometrium cancer. 

Two main hormones are secreted by the ovaries; estrogen and progesterone. The balance between these two hormones varies during menstruation. Endometrium becomes thicker from the early stage of menstruation, if the pregnancy does not occur, the thickened endometrium is shed. The balance between these two hormones increases the risk of developing endometrium cancer, if it goes in favor of estrogen, which stimulates the growth of the endometrium.

Risk factors of endometrium cancer

Factors increasing the level of estrogen;

  • The extended time of menstruation period:

If menstruation starts at an early age (before the age of 12) or in case of late menopause, the risk of endometrial cancer increases. Because the more period is undergone by women, the more endometrium is exposed to estrogen.

  • Women who have never been pregnant:

Without certainty, pregnancy seems to reduce the risk of endometrium cancer. More estrogen is secreted during pregnancy, but more progesterone is secreted. Increased progesterone production can compensate for the effect of increased estrogen.

  • Irregular ovulation: 

Ovulation is the release of eggs from the ovaries on a monthly basis. This cycle is regulated by estrogen. Irregular ovulation or non-existing ovulation increases the exposure of estrogen. Reasons of ovulation irregularities include obesity and polycystic ovarian syndrome (PCOS). In the treatment of obesity and PCOS, monthly ovulation and menstruation are regulated repeatedly. Thus, efforts are being made to reduce the risk of endometrium cancer.

  • Obesity:

Ovaries are not the only source of estrogen. The Adipose tissue also releases the estrogen hormone. In obesity, the level of estrogen in the body increases and therefore including to women in the risk group for endometrium cancer. In obese women, the risk of endometrium cancer increases three times more. However, cancer can also be seen in weak women.

  • Fatty diet:

This type of nutrition pattern can increase the risk of endometrium cancer since it causes obesity, or it can lead to the same result when fatty foods directly affect estrogen metabolism.

  • Diabetes:

Endometrium cancer is more common in women with diabetes because obesity and diabetes are often seen together. However, the risk of cancer is high even in thin women with diabetes.

  • Estrogen replacement treatment:

Estrogen stimulates endometrium growth and administration of only estrogen in the post-menopausal period increases cancer risk. Combined administration of estrogen together with progesterone hormone results in thinning and shedding of the endometrium and therefore reduces the risk of endometrium cancer.  

  • Ovarian tumors: 

Some ovarian tumors are the sources of estrogen and increase the level of estrogen.

  • Advanced age: 

Most of the endometrium cancers are seen after the age of 55.

  • History of breast or ovarian cancer.
  • Use of tamoxifen:

One out of every 500 women, who have breast cancer and receive tamoxifen treatment, is diagnosed with endometrium cancer. Tamoxifen has an estrogen-like effect on the endometrium, leading to thickening of the endometrium. Since it increases the risk of endometrium cancer, everybody who uses tamoxifen should have an annual periodic pelvic examination.

  • Hereditary Nonpolyposis Colorectal Cancer (HNPCC): In this hereditary disease, there is a disorder in an important DNA repair gene. The risk of colon cancer and endometrium cancer is high in people with this hereditary disease.

The presence of these risk factors does not necessarily mean endometrial cancer. However, it should be remembered that these factors make put people at risk and possible findings and symptoms must be considered sensitively.

Diagnostic methods of endometrium cancer

History of the patient is taken at first and physical/pelvic examination is made and transvaginal USG is performed. Endometrium thickness and structure are evaluated here. Then, the biopsy which should be made for final diagnosis is performed as endometrial biopsy without anesthesia in examination room conditions. Dilatation (extension) and curettage (scraping) are applied if an adequate tissue is not available. However, operating room conditions may be required for this intervention. In this method; a sample is taken by scraping from the whole endometrial layer and sent for pathological examination. A final diagnosis is made after these tissues are examined under a microscope. Patients who are diagnosed with cancer are directed to a gynecologist oncologist. If necessary, further evaluation may be required to evaluate the spread of disease ((X-ray, CT, blood tests).

The next step is the staging of disease. Staging is made with surgical treatment of the disease.

Treatment methods of endometrium cancer

Endometrium cancer is a disease that can be completely treated when diagnosed early. In early stages, the five-year survival rate of patients is about 95 percent. Radiotherapy and chemotherapy can also be applied in the treatment, but the most common method is surgery.

Surgical treatment:

It is the most common treatment method. Uterus, ovaries and tubes are removed in the surgical treatment. It is also necessary to extract regional lymph nodes and take samples from the surrounding tissues. The first surgery of the patient is considered to be the most important treatment and is definitely recommended to be made by a gynecologist oncologist. However, according to the extension of disease, surgical treatment is sometimes not sufficient and additional treatments may be needed.

Radiotherapy: 

If post-operative findings indicate the recurrence risk of cancer, radiation therapy is administered after hysterectomy (removal of the uterine).

Hormone therapy:

If cancer has spread to other parts of the body, high doses of progesterone can be given to stop the growth of the tumor.

Chemotherapy: 

Chemotherapy is a drug treatment to kill cancer cells. These drugs are usually used as combinations. If cancer has reached advanced stages and spread to other organs, chemotherapy is administered to kill these cancer cells by reaching them via blood.

Patients are followed up at regular intervals after treatment. During these follow-ups; physical examination, pelvic examination, chest x-ray and laboratory tests are carried out.

Cervix Cancer

Cervix cancer, which is diagnosed in 500 thousand women every year around the world, is the second most common type of cancer following the breast cancer among all women's cancer types. It is noteworthy that it especially increases in developed countries.

What is cervix cancer?

Cervix cancer is a cancer type which develops in the lower part of the uterus called as the cervix. Because it is the lowest region of uterine and provides a passage for vagina, it is called 'cervix cancer' or 'cervical cancer'. It is a very common disease among women. Such that, it is the second most common cancer type among all types of women's cancer. It is remarkable that the incidence of cervix cancer increases especially in developing countries. Every year, 500 thousand women are diagnosed with cervix cancer around the world.

It is possible to explain the formation in simple terms; cells that form the surface of cervix turn into abnormal cells that can be called 'cancer precursors'. Cancer precursors are precancerous structures and they can turn into cervical cancer when they are not detected and treated earlier. The main factor responsible for this transformation is the Human Papilloma Virus, known as 'HPV'. HPV is a virus that causes genital warts and sexually transmitted.

Women are advised to have a PAP smear test every year after sexual intercourse begins. The reason is that changes seen in the cervix can be detected by this test. PAP smear test, also known as Papanicolaou test, enables early diagnosis before abnormal cells in the cervix turn into precancerous structures and cervix cancer. The smear test is an important advantage for women. It is known that wide screening with the PAP smear test reduces cervical cancer rates in developed countries.

Prevention methods of cervix cancer

PAP smear test is recommended during gynecological examinations three years after the first sexual intercourse. After receiving normal results from three consecutive PAP tests over the age of 30, PAP smear test can be done every 2 - 3 years. If there is a normal result of three consecutive PAP tests after the age of 65-70 in the last decade, PAP might not be required.

  • It needs to be taken every year for high-risk women. Situations of high-risk group:

Immunosuppression (where the immune system is suppressed),

HIV infection,

Use of DES (synthetic estrogen).

  • The main target group in terms of vaccination; are young women who are not sexually active, ie are not likely to have had the HPV virus. HPV vaccination is made to be protective against cervical dysplasia, neoplasia, cervical cancer, genital warts (condyloma acuminata) and precancerous anogenital lesions. Even if HPV vaccination is done, the PAP smear test, which is the cervical cancer screening test, needs to be continued. It is suggested to use a barrier method (condom) during sexual intercourse to prevent infection.

What are the symptoms of cervix cancer?

The first symptom is usually abnormal vaginal bleeding. Bleeding is especially seen during or after sexual intercourse. Symptoms include malodorous vaginal discharge, dysuria (painful urination) and vaginal discomfort.

The tumor can spread upwards into the endometrial cavity (intra-uterine cavity), downwards through the vagina and sideways to the pelvic wall. It may directly invade the bladder and rectum. Depending on these spreads, constipation, hematuria (bloody urine), fistula and urethral obstruction (urinary tract obstruction) and hydroureter (urinary tract enlargement) or hydronephrosis (enlargement of the kidney) can be seen. Leg pain, edema and hydronephrosis can also occur due to spreading to the pelvic wall.

Distant organ metastases may involve extrapelvic lymph node involvement and spreading in liver, lung and bone. Cervix cancer is usually seen in middle-aged and older women, but it can occur at any age.

Risk factors for cervix cancer

The risk factors that can cause cellular changes in the cervix are as follow;

  • HPV infection,
  • Age,
  • Sexual intercourse at an early age,
  • The existence of multiple sexual partners,
  • A high number of pregnancies,
  • Multiple partnerships of the man,
  • Abnormal PAP smear test result which is already known,
  • Smoking, 
  • Improper genital hygiene,
  • Using oral contraceptives, nutritional deficiencies (A, C, E, Folic acid deficiency), HIV infection, history of a sexually transmitted disease

Diagnostic methods of cervix cancer

The first finding may be abnormal PAP smear result in the patients who are applied Papanicolaou test during routine gynecological examination and follow-up. Because early-stage cervical cancer is more likely to be detected during the physical examination.


PAP smear test    

When applying this test, the sample taken from the vaginal swab with the help of a brush is evaluated by the pathologists and the normal - abnormal cell classification is performed. Another period when this test is used safely is pregnancy. Today, it is measured that deaths caused by cervical cancer can be reduced by 70 percent as a result of PAP smear screenings. Colposcopy is the tool that allows direct observation of lesions that may be missed by other methods. With this optical instrument, the cervix can be enlarged 6-40 times. If an abnormality is found in the PAP smear results, colposcopy and, if necessary, biopsy are made.  

HPV DNA typing is one of the recommended methods for suspicious results. Patients should be evaluated more frequently if there is a suspicious PAP smear result or HPV DNA is positive. Because the lesion is more likely to progress than the negative patient. HPV DNA screening can also be performed using the liquid-based PAP test method.

Treatment methods of cervix cancer

  • The methods used in the first treatment of cervical cancer are divided into two main groups as surgery and radiotherapy. Radiotherapy is a treatment method that can be used in every stage of cervical cancer. In early stage cancers, the spread of disease is much less and surgical treatment is the first option. The primary treatment method is radiotherapy at advanced stages. In surgical treatment; the primary goal is to clear the primary tumor and possible spreading regions in the cervix. Surgical treatment is based on the following minor surgical techniques according to the size of the tumor: the entire uterus, the cervix, and the large surgical techniques that the lymph nodes receive.

 

LEEP (Loop electrosurgical procedure)

It is an invaluable technique in the diagnosis and treatment of cervical cell cancers. It is a method based on benefiting from the antihemorrhagic effect of electric on the tissue.

Cryotherapy
It is a method based on crystallization of the intracellular wáter, resulting in irreversible damage to the surface tissue of cervix and cell death.


Laser therapy
It can be used in every case where the whole lesion can be seen in spreading cancer and intra-uterine curettage result is good.


Conization
It is a surgical method including excision of a cone-shaped wedge from the cervix, playing an important role in the treatment of cellular changes in the cervix.

Different diseases may show the same symptoms. 

Most of the classic symptoms of cervix cancer can also be seen in benign (non-cancerous) conditions such as vaginal infection, uterus myomas and polyps. Therefore, these symptoms have to be determined by an expert about which disease they indicate.

 
 
 

Let's embrace more women together

 
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Ovarian Cancer

Ovarian cancer, the majority of which is seen in the postmenopausal period, is recovered by 80-90% with appropriate treatments at the early stage while this rate is reduced by 40-50% at advanced stages.

What is ovarian cancer?

There are many different cells in the ovarian tissue. Tumors occur as a result of uncontrolled division and proliferation of embryonic cells or epithelial cells that form the main structure of the ovary. It most frequently occurs with tumors caused by epithelium cells. 80 percent of women diagnosed with ovarian cancer in the post-menopausal period is detected to have tumors which develop in the epithelium tissue. Of the women under the age of 20, sixty percent have tumors which develop in embryonic period. Ovarian cancer is seen in 1.4 out of 100 women throughout the life.

Prevention methods of ovarian cancer

  • Avoiding from carcinogenous substances such as alcohol and smoking, 
  • Having healthy nutrition,
  • Using contraceptive pills as they are known to help reducing the cancer risk,

What are the symptoms of ovarian cancer?

Ovarian cancers do not give a symptom in an early period. For this reason, 2/3 of ovarian cancers are diagnosed at an advanced stage. The reason why it does not give symptom is that cancer grows up in the abdominal cavity and does not disturb the patient for a long time. However; abdominal swelling, inguinal and abdominal pain, malaise might be the symptoms of the disease. In addition, some patients might have gas and digestive disorders. The symptom which emerges in the recent periods of disease is significant weight loss. 

Risk factors for ovarian cancer

It is hard to identify this risk group. About 5 to 10 percent of ovarian cancers occur for genetic reasons. Thus, healthy women with two or more cases of breast, ovarian and endometrium cancer among their first degree relatives are at the risk for ovarian cancer.

Diagnostic methods of ovarian cancer

There is not a specific diagnostic method of ovarian cancer. The disease is diagnosed in many ways. In some of the patients, the diagnosis is made during other researches and surgeries. Therefore, patients with the above-mentioned complaints must be examined by a gynecologist. The presence of the disease is suspected by inguinal ultrasonography performed after the examination.

The actual diagnosis is decided after pathological examination of surgically removed tissues. Tomography and similar screening methods other than ultrasonography are among the methods which help to make a diagnosis. Investigating some substances in the blood, called as tumor indicator, can be used as a supplementary diagnostic method. As mentioned above, since ovarian cancers do not give early signs, annual gynecological examination and inguinal ultrasonography in post-menopausal period can provide early diagnosis of the disease. Postmenopausal controls are important accordingly. Because, 75 percent of ovarian cancers are seen in the postmenopausal period.

Treatment methods of ovarian cancer

The primary treatment for ovarian cancer is surgery. In other words, patients are treated with surgery first. However, the operation performed here is a surgical procedure with special features.
The respond to be given against the treatment is directly related to the adequacy of the first operation. In the early stages of the disease, an operation is performed called as staging surgery together with the removal of the tumor.  

In advanced stages, a comprehensive operation is performed to excise the tumors inside the abdominal cavity. Intestinal portions can also be removed during the surgery if necessary. After surgery, all patients except those at the very early stage are treated with drug treatment called chemotherapy. In other words, drug treatment is applied in a significant part of ovarian cancer treatment.

Advantages of the early diagnosis in ovarian cancer

The success rate of the treatment is directly related to the prevalence of tumor. Early-stage diseases can be recovered by 80-90% while recovery rate is 40-50% in advanced-stage patients. Patients are checked every 4-5 months for many years after surgery and chemotherapy. When the disease recurs, treatments are also repeated. Sometimes, surgeries might need to be repeated 2-4 times.

 
 
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