Dr. Anupama Rajan Babu is a Clinical Professor at Amrita Advanced Centre for Robotic Surgery, Surgical Oncology, Gynaecologic Oncology Division. She talks to HealthWire on range of issue associated Endometrial cancer. Here is an excerpt of the interview.
Q. What is Endometrial cancer, and where does it occur?
Endometrial cancer is a type of cancer which occurs within the uterus. The lining of the uterus is called the endometrium which sheds during each monthly period. Endometrial cancer was not a common cancer in India earlier. However, there is an increase in the number of women suffering from endometrial cancer in India. The incidence of endometrial cancer is rare in women below the age of 40 years. But it is more common in women of 40-65 years of age. As you grow older, the chances of having endometrial cancer also increase.
Q. What are the early signs of this cancer and possible causes?
A: Approximately 80% of endometrial cancers are present in the early stages, i.e., you get a warning symptom. The warning symptoms differ according to the age of the woman. For a woman who has not attained menopause, the symptom could be increased bleeding during menstruation or between cycles.
Women who have attained menopause can show symptoms of bleeding too. This include drop of blood or excessive bleeding. Factors associated with increased risk of endometrial cancer are obesity, diabetes, high blood pressure or hypertension, and nulliparity (i.e. not having any children).
Although there can be different causes for irregular bleeding, it is of prime importance that the person consults the doctor to find out the cause. Just a clinical examination will not indicate whether the uterine lining is normal or not. Sometimes, an ultrasound or a small biopsy from the uterus is necessary. Every woman with irregular bleeding should do a check-up to rule out endometrial pathology after 40. Especially after the age of 50, any abnormal bleeding should be taken seriously and investigated.
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Q. What are the possible treatments available in India right now for this cancer?
A: As cancer mostly presents in the early stages, often, the first treatment option is surgery. Surgery for endometrial cancer involves not just removal of the uterus as we need to see whether the tumor has spread to nearby tissues. Surgery involves the removal of the uterus, ovaries, and tubes and also the removal of lymph nodes. This is called staging surgery, which is the first treatment in more than 80% of endometrial cancer.
Post this surgery, the tissue goes to a pathologist, who will look into it in detail and see whether the cancer has spread or it is still localized. Based on that, they will assign a stage and grade to it. After this procedure, further steps on treatment are decided. After surgery, some patients need to undergo radiation therapy, and very few may have to undergo chemotherapy treatment to help reduce the chance of cancer coming back.
Q. How many stages are there for this cancer?
A: Like other cancers, endometrial cancer also has four stages. Most of the people with this cancer live their normal life span. More than 80-85% of them can lead an everyday life with normal lifespan, if detected at early stages. But, if the disease progresses to stage 3 or stage 4, then your life span decreases. If it is detectedat stage 1, then over 90% of the patients will live more than 5 years.
At this stage, the surgery alone is enough for many patients, and there is a good chance of a complete cure. Since stage 2 involves the cervix, the chances of survival are low compared to stage 1. If the cancer is detected at stage 3, then only 40% to 60% can make it beyond 5 years.
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Q. What is the awareness level and incidence rate for endometrial cancer among women in India?
A: Many women are not aware of this cancer, and they tend to ignore the symptoms of bleeding. When woman is having increased bleeding at the age of 40 -and 45, they turn to friends, colleagues, relatives for advice without consulting a doctor. They consult a doctor only when the symptoms are unbearable.
Additionally, lifestyle changes, shift from rural to an urban community, change in food habits remain a few of the many causes for increasing incidences of endometrial cancer in India.
In India, the incidence is less common among rural areas as compared to urban areas. According to the latest report of India’s national cancer registry program, the age-adjusted rate (AAR) of uterine cancer in cities like Delhi, Chennai, and Bangalore is around 6 per 1 lac women. However, in rural areas, the AAR is less than 1 per one lac women.
Q. What are the tests/diagnostics for this cancer?
A: The process for diagnosis of cancer is simple. There is no requirement for any complicated machinery to diagnose endometrial cancer. You only need an ultrasound and a biopsy from the endometrium. The biopsy from the endometrium can be taken as an outpatient procedure. It is only a 5-minute procedure to take an endometrial biopsy with a pipelle syringe.
Q. What are the other side effects of this therapy?
A: One of the treatments that patients may undergo is chemotherapy. It may cause experience hair loss. But the treatment benefits will outdo the side effects in such a scenario. Earlier, in any open surgery for endometrial cancer, a big incision was required, leading to wound infection, hernia, and pain. With modern techniques, we can perform minimally invasive surgery that reduces the side effects of the treatment.
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Q. How do we tackle a lack of awareness among women regarding endometrial cancer?
A: Women in India generally need more awareness related to cancers affecting women. In terms of endometrial cancer, breast cancer, cervical cancer – awareness is relatively low. Women have to be educated on these issues and be aware of the preventive and treatment options.
Due to a busy lifestyle, they tend to become ignorant of their own body. They postpone their health check-ups due to busy professional life or family commitments. The entire family needs to be educated so that the women’s health is never neglected.
In western societies, there are government initiatives like screening programs, follow-ups that help women tackle these problems. India is a vast country with different needs, and Government initiatives do not always reach the entire country. Hence, it is important to be self-aware and look after your health.
Q. Are obese and diabetes women at risk?
A: They have double the chances of having endometrial cancer than other women. But once you have the cancer, the treatment and outcome are almost the same- whether you have diabetes or is a non-diabetic.
Q. How are robotic – assisted surgeries proving to be beneficial for patients especially with endometrial cancer?
A: More and more doctors are adopting robotic-assisted surgeries for treating endometrial cancer because of its excellent results and advantages. da Vinci surgical systems are preferred by doctors as it offers outstanding clinical outcome. In open surgery, we have to make big incisions, leaving a scar on the body, and there is always a possibility of infection. With robotics, we can do the surgery with better precision and minimal incisions. The incision is less than a centimetre and the finer and precise instruments help in the seamless removal of the uterus, ovaries, and lymph nodes.
Endometrial Cancer surgeries can be done accurately using robotics as it provides 3D vision and better control for surgeons. With traditional surgery methods, the patient usually has to stay in the hospital post-surgery for over a week to recover. Robotic-assisted surgery helps patients recover faster and requires only a short stay at the hospital. Patients can get discharged in a day and return to their regular lives faster and they need not take any injectable pain killers.
Any last takeaways, or any advice you would like to given women?
Endometrial cancer is a lifestyle disease. Chances of endometrial cancer can be reduced to an extent by leading a healthy lifestyle, diet, controlling blood sugar level, and monitoring health regularly.
- If you notice any change in your body, then you must consult a doctor immediately.
- If you are going for a uterus removal, always undergo it after an endometrial biopsy.
- It is important that cancer is diagnosed at the right time.
- Additionally, always get cancer surgeries performed by an on co-surgeon or one who specialises in cancer surgeries rather than general practitioners.
- Lastly, be open to modern technologies such as robotics for surgery. It is a popular misconception that robotics surgeries are done by a robot. This is not true. Robotic-assisted surgeries are performed by skilled doctors using robotics technology as an interface.
- It has made complex surgeries simpler and more comfortable to perform and helps with precision and dexterity while performing surgeries. Whenever you have a technology which can make your life comfortable – use that technology.