Cancer in Women

Cancer in Women

Cancer is characterized by an uncontrolled growth and spread of abnormal cells in the body. If not caught early, this proliferation of abnormal cells -- called a tumor -- can result in death. You should be aware, however, that cancer is not a hopeless disease, but one that can be cured with prompt treatment. Recent advances in cancer therapy have led to nearly 50% of cancer patients remaining alive and free of disease some 5 years after the initial diagnosis.

Cancer occurs in larger numbers among the elderly. It is much more common in people over 65; about 73 million Americans are eventually expected to develop cancer in their later lives. Lung cancer is the leading cause of cancer-related deaths in both men and women, followed by breast cancer in women. The incidence rates and the death rates vary in men and women and in different ethnic groups, based on the type of cancer.

Causes of Cancer

Why does cancer occur? What triggers an occurrence? The reasons are still largely unknown, although the mechanisms of the disease have long been recognized.

The body renews and replaces it cells through a constant process of cell division and growth. Cells exist, repair themselves, die, and are reborn. Old tissues are replaced with new, injuries are repaired, and the body grows and develops. Normally, the body has control mechanisms that limit abnormal cell growth. Cancer cells, however, continue to grow without restraint, dividing many more times than do normal cells. The abnormal cells form tumors, which compete with normal, healthy tissue for nutrients.

Tumors can be benign (harmless) or malignant. Benign tumors can be removed with surgery and usually do not recur. Malignant tumors, on the other hand, can grow, invade, and destroy nearby areas of the body. They can spread, or metastasize, to distant organs and form new tumors. If malignant tumors aren't removed or killed early in their development, they can spread to other parts of the body.

Some cancers spread quickly, whereas others develop slowly. Because cancers can be most successfully treated before they spread (metastasize), it is important to be aware of cancer warning signs and steps that can be taken for early detection of the disease.

Methods of Early Detection

The American Cancer Society has identified certain warning signs that should alert you to see your doctor promptly (see "Warning Signs of Cancer"). None of these signs necessarily means that you have cancer, but each one is important and warrants immediate medical attention. Pain is seldom a symptom of early types of cancer, so don't wait until it hurts if the other symptoms don't disappear on their own.

Certain tests can also help detect cancer in early stages. These screening tests are often done routinely for people who may have symptoms of a disease and for those who have risk factors, such as age and family history. Every woman should have a physical examination annually and undergo the following routine screening tests as needed.

Pelvic examined Pap test (annually after age 18 or once sexual activity has begun) to detect cancer of the cervix, ovary, or uterus
Mammography (every 1-2 years until age 40- 49; yearly thereafter) to detect cancer of the breast. High-risk women may benefit from earlier screening
Fecal occult blood test (annually after age 50) to detect hidden blood in the stool, which may be a sign of cancer of the colon and rectum
Sigmoidoscopy (every 3 to 5 years after age 50) to detect changes in the colon or rectum that could be a sign of colon and rectal cancer

These tests may be done earlier in women who have special risks. For instance, if you have a family history of cancer of the breast or colon, you will benefit from having tests to detect these diseases more than women who have no family history of disease. Colonoscopy, a test used to view the inside of the entire colon, is recommended in women age 40 and older who have had inflammatory bowel disease or who have a family member who had cancer of the colon or rectum at an early age.

Be alert to any changes in your body. Besides scheduling a yearly pelvic exam, you should regularly examine you breasts. Many breast lumps have been found through self-examination. It is best to do the breast examination at the same point in your menstrual cycle each month (or on the same day of the month if you're postmenopausal), because breast tissue changes with your cycle. It will be easier for you to detect anything unusual if you follow this suggestion. Check out other areas of your body, including your skin, for any suspicious signs.

Have your mouth checked periodically by a dentist. In addition, use a mirror to examine your mouth. Changes in the color of the gums, lips, or cheeks as well as sores, swelling, bleeding, or thickening of any tissue should be reviewed by your doctor.

The Seven Warning Signs
of Cancer

1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or lump in the breast or elsewhere
5. Indigestion or difficulty swallowing
6. Obvious change in a wart or mole
7. Nagging cough or hoarseness

Risk Factors of Cancer

About 80 percent of all cancers may be related to the things we eat, drink, and smoke and to the quality of our environment and workplace. Repeated and long- term contact with cancer-causing agents (carcinogens) can damage cells or change cells that are already damaged and lead to cancer. For example, tobacco smoke is one of the most potent carcinogens, and it acts with other elements, such as alcohol, to increase the risk of certain cancers.

Tobacco

Smoking is a major risk factor for cancer. The risk of dying from lung cancer is 12 times greater in a smoker than in a nonsmoker. Overall, smoking causes 30 percent of all deaths from cancer. In addition to contributing to lung cancer, it also increases the risk of cancers of the cervix, mouth, throat, esophagus, pancreas, bladder, and possibly the stomach. Smokers also have a higher rate of cardiovascular and respiratory disease. Household members of smokers are also at risk for cancer.

If you smoke, quit. As soon as you stop smoking, your risk of cancer decreases.

Diet

A high-fat diet has been linked to certain types of cancer, including cancer of the breast, colon, rectum, and ovaries. Obesity has been linked to increased cancer death rates. The exact link between diet and cancer is not clear, but most health practitioners agree that it is best to eat a variety of foods, to limit saturated fats and cholesterol, and to eat foods high in fiber. Eating fresh fruits and vegetables daily may decrease your risk of cancer by as much as 50 percent. An increased daily intake of vitamins A, C, and E may also boost your protection against lung cancer.

Sunlight

One of the most common forms of cancer in the United States is skin cancer, which is caused by exposure to ultraviolet (UV) radiation from the sun. Repeated exposure to the sun may be especially harmful for people who have fair skin or who burn or freckle easily. Take steps now to avoid the sun, especially during the hours of 10:00 a.m. and 2:00 p.m. , when the sun's rays are strongest. If you are out during those times, wear protective clothing, including a hat. Use sunscreen to block the UV light. Remember, a tan is really the body's attempt to protect itself against the sun.

Alcohol

Cancers of the mouth, throat, esophagus, and liver occur more often among heavy drinkers, especially those who smoke as well. Alcohol also poses a number of other health problems. If you regularly drink more than two drinks a day, you should probably consider cutting back or stopping drinking altogether.

Chemicals

Exposure to certain industrial agents or chemicals increases the risk of various types of cancer. Exposure to these chemicals may occur in the workplace, outdoors, or at home. They include

Asbestos fibers
Nickel, chromate, and vinylchloride
Solvent cleaners, cleaning fluids, and paint thinners
Lawn and garden chemicals (pesticides and fungicides)

Avoid inhaling any of these chemicals, especially in areas that are not well ventilated. Read labels carefully and avoid having these agents come in contact with your skin or household items (see also Chapters 5 and 6).

Hormones

Certain cancers are stimulated by an excess of the female hormone estrogen. Estrogen occurs naturally in reproductive-age women. It is also the main component of birth control pills and hormone-replacement therapy after menopause. Birth control pills have not been linked to cancer in most women, however, and they may even protect against some types of cancer. Replacement of estrogen alone can increase the risk of endometrial cancer in postmenopausal women, but when it is combined with the hormone progesterone, the risk is lowered. Before taking estrogen, discuss the risks with your physician.

Genetics

Some cancers may be inherited. The risk of breast, colon, and skin cancer, for instance, is higher in some families than in others. Your risk for these cancers is high if you have a first-degree relative (mother, father, sister or brother) who developed one of these cancers. If you have close relatives who have had cancer, tell your doctor. He or she may advise that you receive regular checkups and tests.

Types of Cancer

Cancer in women can be nongynecologic or gynecologic. Nongynecologic cancers occur in both men and women. Gynecologic cancers, however, are unique to women; they occur in the female reproductive and genital organs. (Although breast cancer can occur in both men and women, it is considered here as a gynecologic cancer, because it is much more common in women than in men.) For more details about all of these cancers, see the chapters where the specific body parts are discussed. (See Fig. 37.1).

Nongynecologic Cancers

Lung

Today, lung cancer is the most common cause of cancer death in American women, resulting in the death of 59,000 women in 1994. The rate of occurrence as well as the death rate from lung cancer is on the rise in both white and African-American women.

The main cause of lung cancer is cigarette smoking. Other less common causes are exposure to radon gas, asbestos, and radiation.

The specific warning signs of lung cancer are as follows:

A cough that won't go away
Sputum streaked with blood
Chest pain
Repeated attacks of pneumonia or bronchitis

There are no screening tests for lung cancer, and it can be difficult to diagnose. Nearly 50 percent of patients diagnosed with lung cancer receive care too late to be cured. Diagnosis is based on chest X-rays, examination of the cells in the sputum, biopsy of the suspicious area, and imaging tests of the bronchial tubes. Survival rates are low and based on the stage of disease. Surgery is the main form of treatment, followed by chemotherapy. Some cancers will be treated by radiation therapy. The best way to combat lung cancer is prevention by stopping smoking.

Colon and Rectum

Cancer of the colon (the large bowel) and rectum (the last 8 to 10 inches of the large bowel, which leads to the anus) is the second most common cancer in women. Although the death rate from colon and rectum cancer is decreasing in white women, it is remaining steady for African-American women. This form of cancer occurs more often in older women, in those who have a history of inflammatory bowel disease, and in women who have a family history of cancer of the colon or rectum. A diet high in saturated fat and low in fiber appears to increase the risk of this disease, and increased daily intake of fiber, fruits, and vegetables seems to protect against it.

Cancer of the colon and rectum can be detected early. The following persistent symptoms are warning signs of a possible problem:

Diarrhea or constipation (recurring or alternating)
Blood in or on the stool
Stools that are narrower than usual, indicating obstruction
General abdominal discomfort (bloating, fullness, or cramps)
Frequent gas pains
A feeling that the bowel doesn't empty completely

These symptoms could be a sign of a number of things, so it's important to ascertain the cause without delay. The diagnosis is based on a physical examination and tests that detect blood in the stool or growths in the colon or rectum. Sometimes a piece of a growth can be removed for further study (biopsy). The most common treatment for bowel cancer includes surgical removal of the diseased area, and follow-up chemotherapy may be recommended.

Bladder

Each year, more than 13,000 American women will be diagnosed with bladder cancer. If the disease is treated early, the cure rate is good. Cancer of the bladder is twice as likely to occur in women who smoke as in women who don't smoke. The main symptom is blood in the urine and the need to urinate more often than normal. Pain rarely occurs in the early stages, and there may be no symptoms at all.

Diagnosis is based on physical examination, laboratory tests, and imaging studies. A urine sample may reveal cancer cells. Since the cancer usually occurs inside the bladder, a test may be done using a thin lighted tube that is inserted inside the bladder. A sample of any growth may be removed for further study. Bladder cancer is usually treated surgically.

Skin

Skin cancer is the most common form of cancer in the United States, with about 700,000 new cases annually. It is estimated that 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. Caused by exposure to ultraviolet light, skin cancer occurs more often in regions that traditionally have more sunlight. Basal cell carcinoma, a slow-growing cancer that usually does not spread to other parts of the body, accounts for more than 90 percent of all skin cancers. It usually appears as pale bumps or red scaly patches. Squamous cell skin cancer can spread to other areas and must be removed surgically. Multiple melanoma is invasive and life threatening. It first appears as a molelike growth that gets bigger, darker, and more inflamed. (See Fig. 37.2)

Warning signs of skin cancer include

A change in the size or color of a mole or wart
Scaliness, oozing, or bleeding
Itchiness, tenderness, or pain in a bump or a mole
A sore that does not heal

Regular self-examination is the best way to detect skin cancers. Inspect all moles carefully and look for any changes. Examine all parts of the body, because melanoma can appear in places that have not been exposed to sunlight. The cure rate is nearly 100 percent if skin cancers are treated before they spread.

Pancreas

The pancreas, a large gland located behind the stomach and in front of the spine, makes enzymes that digest food as well as insulin, which controls the amount of sugar in the blood.

Cancer of the pancreas is a common cause of death in women. It is known as a silent disease, because there are no symptoms in the early stages. As a result, the cancer has often spread by the time it is diagnosed, which makes for low survival rates. Symptoms are pain in the upper abdomen and sometimes the back, nausea, loss of appetite, weight loss, and weakness.

Oral

Cancers of the mouth, lips, gums, cheeks, teeth, jaw, and tongue are usually found in people over age 45. The best way to detect oral cancer is through self- examination. Look for the following warning signs:

A sore that bleeds easily and doesn't heal
A lump or thickening
A red or white patch that doesn't go away
Difficulty chewing, swallowing, or moving tongue or jaws

Women who smoke, especially if they also drink alcohol, are at an increased risk for oral cancer.

Diagnosis is established by taking a biopsy of any lump or abnormal area and examining it under a microscope. Imaging tests also may be done to see if the disease has spread to other parts of the body. If caught early, many of these cancers can be cured.

Gynecologic Cancers

Breast

Breast cancer is occurring in epidemic proportions in the United States. About one of every nine women will develop breast cancer during her lifetime. African- American women, who are less likely than white women to develop breast cancer, are more likely than white women to die from it. Formerly, it had been thought that African-American women postponed seeing a doctor or did not have access to care, resulting in the disease being diagnosed in later stages. Recent research, however, indicates that a more aggressive form of the disease may afflict African-American women, particularly younger ones.

Women who have a mother or a sister who has had breast cancer are at increased risk of getting the disease. The risk is also higher in women who have not had children or who had children later in life. Breast cancer has also been linked with alcohol use and a high-fat diet.

The best way to detect breast cancer is by doing a monthly self-examination, seeing a doctor annually for an examination, and by having periodic mammograms. The warning signs of breast cancer are

Changes in the breast that don't disappear -- a lump, thickening, swelling, or dimpling
Irritation of breast skin
Nipple distortion, retraction, or scaliness
Discharge from the nipple

The earlier breast cancer can be found and treated, the better the chance of cure. Breast cancer can spread to the bones, liver, lungs, or brain, making it very difficult to treat in later stages.

The first stage in diagnosis is feeling for any breast lumps. Your doctor may use a needle to withdraw fluid or a piece of the lump so that it can be studied in a laboratory. Treatment of breast cancer depends on how advanced the cancer is at the time of diagnosis. (See Chapter 25).

Cervix

The cervix, the narrow neck of a woman's uterus, can go through a series of changes that eventually can lead to cancer. Cervical cancer is the third most common form of cancer of the female genital tract and accounts for 19 percent of all cancers. Cervical cancer occurs almost twice as often in younger African-American than in age-matched white women; over the age of 65, African-American women develop cervical cancer about three times more often than white women. Death rates follow similar patterns, with African-American women dying more often from the disease.

Risk factors for cancer of the cervix include having sex at an early age, having multiple sexual partners, and smoking. Women without any of these risk factors can also develop cervical cancer, however.

A precancerous or localized condition of the cervix can develop over time into invasive cancer. There may be no warning signs with early cervical cancer. More advanced cervical cancer can be signaled by abnormal bleeding or vaginal discharge. Changes in the cervix can be detected through regular Pap tests. Precancerous changes in the cervix can be treated before they become cancerous.

To confirm the diagnosis, a biopsy is done. A sample of tissue from the cervix is removed and studied under a microscope. If detected early, the cancer can be removed surgically. For prevention, always have a Pap smear test done at least once a year after the age of 18.

Endometrium (Uterus)

Cancer of the uterus accounts for 5 percent of all cancers in women and is the most common gynecological cancer. Most cancers of the uterus occur in the endometrium, the lining of the uterus.

Endometrial cancer occurs most often in older women; it is rare before age 40. Cancer of the endometrium is more likely to affect women who are infertile, began menstruating at an early age, don't have children, have menstrual problems, and go through menopause at a later age. Other risk factors include obesity, diabetes mellitus, hypertension, and use of estrogen. Gallbladder disease and thyroid disease may also be associated with increased risk.

The most common symptom of cancer of the endometrium is abnormal bleeding or discharge from the vagina. Because this disease often occurs in women around the age of menopause, they may mistake this symptom for a menstrual period. Any bleeding or discharge that appears after menopause should be checked by a doctor.

Cancer of the endometrium is diagnosed by removing a piece of the lining of the uterus for further study. A hysterectomy (removal of the uterus) is the usual treatment.

Ovary

The ovaries are located on either side of the uterus; each month during ovulation one of the ovaries releases an egg. These glands also produce estrogen. Cancer of the ovary is the second most common gynecologic cancer and the fourth leading cause of death from cancer among women.

Risk factors for cancer of the ovary include a family history of the disease. It generally develops after menopause and is seen more often in women who have had no children or who had trouble conceiving. It is often hard to detect until it is in the advanced stages, when the following warning signs occur.

Discomfort in the pelvic region
Indigestion, gas, or bloating
Pain during intercourse
Abnormal vaginal bleeding
Pain and swelling in the abdomen

There is no good method of screening for cancer of the ovary, although the use of two tests, ultrasound and a blood test for a protein called CA125, show promise. Any abnormality should be checked by a doctor. Imaging tests may be done to get a better idea of the size of a growth. Surgery to remove the ovary, and any other affected organs, is an important part of treatment.

Vulva and Vagina

Cancer of the vulva and vagina are rare and occur most often in older women. Warning signs include a lump or sore on the vulva (external genitals) or in the vagina.

Risk of vaginal cancer is increased after radiation of the cervix, chronic irritation, and uterine exposure to the hormone DES. Diagnosis is determined by removing a sample of tissue for further study. If detected in the early stages, cancers of the vulva and the vagina can be treated successfully.

Types of Cancer Treatment

Although a diagnosis of cancer is serious, it no longer carries the dire consequences it once did. Nearly 50% of all patients diagnosed with cancer can now be cured because of advances in early detection and treatment. The type of treatment is based on the stage of disease. It can involve surgery, radiation therapy, chemotherapy, or a combination of these. Emotional support is invaluable in helping patients with cancer deal with the physical and psychological aspects of their disease.

At the time of diagnosis, the extent of the disease is determined. Called staging , this is a useful way to determine whether cancer is localized or has spread to other areas. Additional staging is used to determine types of treatment and possible outcomes. One method of classification is historical stage , which relates the extent of cancer at the time of diagnosis to the natural history of the disease. The localized stage refers to a cancer that is confined to its place of origin. The regional stage refers to disease that has spread beyond its place of origin to surrounding areas. The distant stage is cancer that has spread extensively to distant tissues or organs.

For localized cancer, surgery is often used to remove the affected tissues. During the surgery, a lymph node or nodes may be removed for examination to see if cancer has spread to the lymphatic system, where it can be spread to other parts of the body.

Radiation therapy is another form of local therapy. Treatment can be directed to particular areas of the body, or radioactive units can be implanted at the site of the cancer. For other cancers, the whole body may receive radiotherapy. Radiation can be used occasionally before surgery to shrink tumors or after surgery to destroy any remaining cancer cells.

Drug therapy, known as chemotherapy, uses drugs to destroy cancer cells. These chemicals interfere with the cells' ability to grow and multiply. The drugs may be administered orally or intravenously. Chemotherapy can destroy healthy cells as well as cancer cells. Side effects of chemotherapy vary and are strongly related to the specific drug or drugs given as well as the type and extent of disease.

Antihormonals block the body's production of specific hormones. The growth of some cancers is stimulated by hormones, and antihormonal drugs limit that stimulation. One such drug is tamoxifen, which is used to treat some breast cancer. Because this drug interferes with the actions of estrogen, women who take it may develop symptoms of menopause.

Some types of cancer therapy have side effects, some more severe than others. Many side effects are temporary, and many can be successfully managed so that the patient is as comfortable as possible.

The Aftermath of Cancer: What You Can Do

Cancer changes the life of the person who has it as well as the lives of the family and friends of that person. If you suffer from cancer, you may have initially reacted to the disease with anger and denial and now feel a range of emotions from hope to despair. More important, you may feel that you have suffered physical and emotional losses that you find hard to deal with and that prevent you from moving ahead to continue on with your life.

Support groups, psychologists and psychiatrists, and families and friends are important recovery resources.

The Future of Cancer Research and Cancer Care

Research in new areas of cancer prevention and treatment is ongoing. One area of research is directed toward examining cancer at the molecular level. By identifying genes that may cause cancer or may make one more susceptible to cancer, scientists hope to be able to target people who are at risk so they can receive early treatment and may even be able to avoid getting cancer at all.

Other research efforts are being directed toward antioxidants, chemicals that consume free radicals, which are waste products produced by our bodies. Some evidence suggests that free radicals may cause cell damage and degeneration. Other research is trying to find ways to boost the body's natural immune response, so it can fight cancer wherever it appears in the body.

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