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Cervical Cancer

Cervical Cancer has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually.

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…..to her, she was doing this to help her only child whom she gave birth to while in the penultimate year of secondary school.  Regrettably, she said, ‘ i had aborted a couple of pregnancies and had sex with several men while in secondary school and by then i was seventeen because i had to fend for myself as an orphan who had no one to help me, but this child just could not be aborted’.     … that is the result the doctor said. She has stage III cervical cancer at age forty-five…

Overview

Womanhood is a world on its own and it takes patience, knowledge, and pity sometimes for one to dabble into such world. They have their own peculiarities in every sphere of life. In the medical world, as cancer remains one monster to deal with, peculiar to women are some cancers like breast, cervical cancer. In this article, I would focus on cervical cancer which from my own little experience most women don’t know about until they come down with it.

Cervical Cancer

The cervix ( pronounced: saviks) is the neck or narrow portion of the uterus(womb) where it joins with the vagina. Cancer is simply when cells of a particular tissue undergo uncontrolled (and often rapid) growth. Thus cervical cancer is the cancer of the cervix.

Cervical cancer is the second commonest malignancy after cancer of the breast in women in developing countries ( Nigeria inclusive) and it remains the leading cause of death in these countries but the third commonest cancer in women in the world. Peak age when women present in Nigeria is 45 to 55 years. However, it is diagnosed in any woman of reproductive age group.

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The causes have been attributed to

  • Genital infection with human papilloma virus
  • Sex at a young age
  • Multiple sexual partners
  • Promiscus male partners
  • One who had or has a sexually transmitted infections. It is important to point out that HIV infection is associated with a very high increase in risk of cervical cancer.
  • Also, a patient with cervical intra-epithelial neoplasia can progress to cervical cancer

What makes the Doctor think A patient has it

*Though, there are some that may not have any symptom but will come to the hospital with abnormal Papanicolaou (Pap smear) result. This is in those that do screening

* abnormal bleeding from the vagina, majorly after sex

* bleeding from the vagina between menstrual period or after menopause

*offensive vaginal discharge which is characteristic

*pain on pelvic side

For those women that present late, they may have in addition

  • Backache
  • Leg pain/ swelling
  • Blood in the urine or bloody urine

Or the doctor investigates by looking at the cervix called colposcopy

How does the Gynaecologist treat

The treatment modality depends on the stage of cancer the patient presents with.

  • It may be surgery if it is at the early stage or
  • The use of radiation and chemotherapy for the more advanced cases
  • Or the use of chemotherapy or radiation for palliation for cases that have developed other things from it

Survival

There is a similar 5-year survival rates for radiotherapy or surgery for someone with the cancer. This survival also depends on the stage of the cancer. If stage I there is 70-80% survival rate but stage IV has 18% survival rate.

What is in this for YOU! 

The major cause of this disease has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually. Condom use may not prevent the transmission. The HPV 16 and 18 are the major serotypes of the cause. Thus, a lady or woman who has been introduced to sex life should get screened two years into sex life and every 3-5 years. In essence, those who should have PAP SMEAR done are

  • Ladies who have started having sex
  • Or above age 21

The American Cancer Society, American College of Obstetricians and Gynaecologist recommend that

  • 21-29 years should have pap smear alone every 3 years
  • 30- 65 years pap smear every 3 years or HPV and cytology testing every 5 years
  • Greater than 65 years no screening recommended
  • Less than 25 no screening recommended because women aged 21-24 are at low risk for invasive cervical cancer but they are at high risk for HPV exposure and associated lesions.

Any Vaccine.

The joy here is that, one could be vaccinated against the Human Papilloma Virus (which is not only for girls but also available for boys) but for girls majorly. The vaccine is useful in those who have not had the disease and no usefulness in one who already had it. The two HPV vaccines approved in the United States of America are Gardasil and Cervarix.

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THE GIST HERE is, please go and get PAP SMEAR done today and tell others about it. It is for your future, in other to live a meaningful life insha Allaah. So please present YOURSELF at any Government health care facility for details.

…. her sex partners were no longer patronizing her since they got to know about her disease as she even was no longer interested in that. She was no more lively, seems no hope for her. Her Chemotherapy drug has made her loose her hair, no beauty to display any longer. The radiotherapy also played it own part on the pelvis. At last, she gave up the ghost with a repentant soul. Don’t ask me if God would accept such repentance.  I leave YOU TO JUDGE…. this woman, this cervical cancer.

I.O Dada (Haniif ibn Toyin)

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Blood Cancer: The Leukemias

Just like any other cancer which is basically an abnormal, uncontrolled cell growth, the human blood is not left out of this inferno. Blood cancer is literarily a condition whereby blood cells continue to proliferate uncontrollably.

Leukemia Symptoms, Types, Causes, Diagnosis, Treatments, Prevention, Nutritions, Cure (1)

What is Leukemia?

Leukemias are a heterogeneous group of malignant disorders which is characterized by uncontrolled clonal (single cell) proliferation of blast cells in the bone marrow and body tissues. To put it simply, imagine a pregnant woman delivering 100 premature babies every year whenever she gets pregnant!

Blast cells are immature blood cells. Blood cells go through about 5 stages before they become mature and are able to perform their functions. In leukemia, immature cells accumulate and are unable to reach their full matured state.

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Blood cells produced in the bone marrow (the soft spongy center of long bones of the arms and legs) include; The Red Cells, White Cells, and Platelets.

While the red cells are responsible for carrying oxygen, providing nutrients to body cells and tissues to ensure their survivals as well as transporting waste products away from those same cells,

The white cells act as defense mechanisms of the body to fight and guard against infections. They are basically the B (The Myeloid cell line) and T cells (The Lymphoid cell line).

Platelets are responsible for the formation of blood clots at sites of injury.

Stages of Blood Cells Production.

Leukemia can be Acute- (of short, quick and fatal onset) or Chronic- (continues over an extended period of time) while it is being managed.

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ACUTE LEUKEMIAS

Characterized by 20% or more of blast cells in the bone marrow. It is of abrupt onset and is rapidly fatal. The survival rate is <6 months without treatment. The more recent WHO classification of acute leukemia relates it with other Chromosomal Abnormalities E.g. Down Syndrome.

Acute Lymphoblastic Leukemia (ALL) is the most common Leukemia in children falling off by 10 years with a secondary rise after the age of 40 years. Its incidence is highest at 3 to 7 years while Acute Myeloid Leukemia is most common in adults.

Causes of Leukemias

There is no exact known cause but several risk factors of leukemia just like every other cancer, however, for Acute Leukemias;

  • The first event is thought to occur in the fetus in utero due to environmental exposure during pregnancy.
  • It may arise as a postnatal (after birth) mutation in early lymphoid cells in the bone marrow.
  • The secondary event is precipitated by infection in childhood due to the mechanism of abnormal response of the child’s immune system to infection.

It is of utmost importance to exclusively breastfeed babies for the first six months of life this boosts the child’s immune system and the introduction of a balanced diet in complementary feeding.

Furthermore, children with high level of social activity like those attending day care have reduced incidence of ALL because of exposure to common infections boosting their immune system

Symptoms and Features of Acute Leukemia include:

  • Fever
  • features of mouth, throat, skin and respiratory infections
  • Marked cervical lymphadenopathy
  • Testicular swelling
  • Spontaneous bruises, purpura and bleeding gums.

Leukemia-symptoms

 Laboratory Diagnosis

1. Bone marrow infiltration checked with bone marrow biopsy

  • Anemia (Reduced Blood hemoglobin concentration)
  • Leucopenia (Reduced white cells count)
  • Thrombocytopenia (Reduced platelet count)
  • Hypercellular bone marrow with >20% blast cells.
  • Infiltration of organs Liver, Spleen and lymph nodes.

2. Cerebrospinal fluid examination contains blast cells (CSF is meant to be a clear colorless fluid which cushions the brain)

3. Increase uric acid as a result of bone degradation with deranges Liver and renal function tests

4. Radiography may include lytic bone lesions

5. Other tests like a CT scan which may be needed for staging as well as other investigations depending on the salient signs

Treatment

Supportive Therapy: Prompt treatment of any episode of fever, blood and blood products support.

Specific Therapy: Chemotherapy, Radiotherapy, Short and intensive courses of drugs.

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The physician (Hemato-Oncologist) decides which is the best approach to treatment according to severity.

 Complications

An unfortunate complication of acute leukemia is DIC Disseminated Intravascular Coagulation

  • DIC is a disorder characterized by excessive inappropriate activation of coagulation and formation of small clots in the blood vessels. These clots block the flow of blood and are a leading cause of death in acute Leukemia.
  • The activation of clot formation is caused by road- like clumps of granular materials in leukemic cells called Auer Rods. This can as well lead to bleeding from the digestive and respiratory tracts as all platelets are used up in the formation of these clots.

CHRONIC LEUKEMIAS

Could be chronic myeloid or chronic lymphoid leukemia according to the cell line affected. It is characterized by rapid proliferation and growth of MATURED blood cells within the bone marrow.

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Hypercellularity (increased amount of cells) of any of the different blood cells (eg White Blood Cell or Red Blood Cell) is a diagnostic feature. It is mostly asymptomatic and detected mostly in routine blood checks. It is nominated according to the predominantly increasing cell;

  • White cells increasing predominantly- Chronic Myeloid Leukemia or Chronic Lymphocytic Leukemia
  • Red cells increasing predominantly- Polycythemia Rubra Vera
  • If it’s the platelets increasing predominantly then we refer to as Essential Thrombocythemia

The Chronic leukemias account for about 15% of Leukemias and can occur at any stage.

Chronic Leukemia is managed appropriately at this hypercellular stage. It is stable indolent and slow progressing. All efforts by medical personnel managing the condition are aimed at not progressing from this stage into the accelerated phase where symptoms begin to manifest and ultimately to blastic transformation. (Transformation to the acute phase)

General Prevention of Leukemias

Prevention is aimed at reducing your risks of leukemia since there is no known cause for leukemia as well as other various types of cancers.

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Risk factors include;

  • Occupational exposures to certain chemicals such as benzene
  • Smoking and other uses of tobacco products
  • Exposure to large amounts of radiation
  • Down Syndrome or other types of genetic abnormalities
  • Smoking, other uses or exposure in pregnancy and in childhood to tobacco smoke (passive smoking).

TREATMENT

The treatment for cancers are quite expensive and drain resources. This is even more so when the five-year survival rates aren’t encouraging, however, new treatments are emerging that can change the outcomes into a better prognosis.

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Immunotherapy is the “treatment of disease by inducing, enhancing, or suppressing an immune response”. Immunotherapies designed to elicit or amplify an immune response are classified as activation immunotherapies, while immunotherapies that reduce or suppress are classified as suppression immunotherapies.

What holds true for most blood cancers is that the earlier you detect it, the better you can reign it in.

Summary

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Mariam Mojisola Solate-Eshinlokun is a Medical Laboratory Scientist (B.MLS, AMLSCN) in Hematology and Immunohematology. She also has an M.Sc in view. She’s from Ogun state, a wife, mother and currently practice at the National blood bank, Khartoum Sudan.

 

​ABNORMAL MENSTRUAL BLEEDING

 

Most women have, at least, a rough idea of when to expect their monthly visitors – the menses. But some are not so lucky. The visitor can just decide to barge in at any time. Irregular menses can be very embarrassing, frustrating and distressing. 
I have discussed normal menstrual cycle on this blog before, read it here… http://wp.me/p72X3S-1U

Let’s look at some of the definitions of abnormal menses. 
*Menorrhagia – heavy menstrual flow, which can be described subjectively as the need to change pads more frequently than before. 
*Metrorrhagia – prolonged menses lasting for more than 9 days. 
*Menometrorrhagia – combination of heavy and prolonged menses. 
*Hypermenorrhea – cycle length shorter than 24 days. 
*Hypomenorrhea – cycle length greater than 38 days. 
*Amenorrhoea – absence of menses for 3 or more consecutive months. 
*Inter-menstrual bleeding – bleeding or spotting in between the menstrual cycles. 
*Post-coital bleeding – bleeding or spotting after sexual intercourse. 
*Post menopausal bleeding – bleeding or spotting after menopause (after at least one year of confirmed menopause) 
*Irregular menstrual cycle – more than 7-9 days of disparity in lengths of cycles. 
What are the causes of irregular menses? 

Irregular menses are commoner in pubertal girls (11-14years) and older women who are approaching menopause. Other than these, irregular or abnormal menses can be due to any of the following – 
*Psychological stress, physical exertion, or sudden change in diet, environment, etc. 

*Problems with ovulation 

*Uterine fibroids

*Adenomyosis (a condition in which the uterine lining – endometrium – grows into the wall of the uterus) 

*Use of contraceptive pills and devices 

*Miscarriage 

*Ectopic pregnancy 

*Bleeding disorders

*Hormonal imbalance 

*Infections of the genital tract including the uterus 

*Cancers of the genital tract

*Co-morbid medical conditions such as diabetes, obesity, etc. 

*Some drugs, alcohol, tobacco smoking, etc. 
Management of abnormal menstrual bleeding depends on the cause. You need to visit a doctor who will take a detailed history and carry out some tests to determine the cause. 
Some of the tests you have to do are:

*Pregnancy test

*Ultrasound scan

*Endometrial biopsy 

*Hysteroscopy

*CT scan or MRI, if indicated 

*Full blood workup

*Hormonal profile 
Of course, treatment depends on the cause or definitive diagnosis. This can be medical or surgical. Certain general measures can be used to restore normal menses; such as weight loss and stress management. 
In conclusion, menstrual disorders and irregularities are quite common. It is important to understand the mechanism of normal menses, so as to be able to detect any anomaly and seek professional advice for prompt investigation and treatment. 

ECTOPIC PREGNANCY

a rebellious embryo may decide to implant itself outside the uterus!

After the fertilization of the egg by a viable sperm, the resultant embryo travels from the fallopian tube down into the cavity of the uterus. Implantation occurs when the embryo is attached to the uterine wall and continues to develop until full term gestation.

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However, for reasons that are not fully understood, a rebellious embryo may decide to implant itself outside the uterus!

Ectopic Pregnancies (EP) account for about 11:1000 pregnancies. More than 80% of such rebels implant in the fallopian tube, hence the name “Tubal Pregnancy”, often used interchangeably with EP.

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Other recognized locations of EP are the abdominal cavity, ovaries, cervix and cesarean section scar.

Because of the limited space for growth within the tube or other ectopic sites, rupture and severe internal bleeding could occur starting from 6-8weeks. Ruptured EP is a life-threatening condition and one of the major causes of maternal mortality.

What are the risk factors for EP?

  • Previous history of EP
  • Previous history of infertility and its treatment (assisted reproductive techniques)
  • Pelvic inflammatory disease (PID)
  • Intrauterine contraceptive device use at the time of conception
  • Endometriosis (presence of the uterine lining outside of the uterus)
  • Pelvic or tubal surgery
  • Smoking

The only way to ensure prompt diagnosis and treatment of EP is to have a high index of suspicion by recognizing the telltale signs.

 

The symptoms are variable and non-specific but there is a classical triad reported by many patients:

  1. Missed period (6-8weeks)
  2. Lower abdominal pain
  3. Mild vaginal bleeding or brownish discharge. 

 Other symptoms include:Shoulder tip pain (sign of internal bleeding-ruptured EP),  Sudden collapse (due to severe blood loss)

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    A diagnosis is usually confirmed by identification via ultrasound scan, supported by the level of an early pregnancy hormone known as Human Chorionic Gonadotropin B (BHCG). The modality of treatment depends on the clinical status.

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    *Surgical management – in ruptured EP, with acute severe blood loss, emergency surgical intervention must be done, together with blood transfusion to save the patient. 

    *Medical management – using methotrexate, in clinically stable patients who are compliant 

    *Expectant/Conservative management – in small sized EP and falling BHCG where the body is expected to get rid of the “rebel” by itself. This is reserved for a select few cases.

    Below is a summary of events in a woman with ectopic pregnancy and how the doctor chooses how best to help her.

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    ABORTIONS

    Abortion is defined as the termination of pregnancy before the age of viability (varies from country to country; 20 weeks in the US, 28weeks in Nigeria) or loss of a foetus weighing 500 grams or less. Abortion can be spontaneous or induced. Some gynecologists often prefer to use the word “miscarriage” for a spontaneous abortion. 

    It is estimated that up to 50% of all confirmed and unconfirmed human pregnancies will result in an abortion. However, by the 8th week of a viable gestation, the chances of a spontaneous abortion occurring drops to only 2-3%.

    Bleeding from the vagina is the commonest symptom of abortion. 30% of pregnant women experience some form of bleeding in the first trimester. About 50% of them will end up with a spontaneous miscarriage. Therefore, it is important to understand that, apart from impending abortion, bleeding during pregnancy could be due to other causes such as:
    *lower genital tract infections 

    *unprovoked or post-coital bleeding due to increased friability of the cervix

    *ectopic pregnancy (implantation of the embryo in any location outside the uterus) 

    *implantation bleeding

    What are the causes of miscarriage? 
    *Genetic causes – foetal genetic anomalies account for 70% of 1st trimester miscarriages 

    *Uterine causes – abnormal anatomy, growths or adhesions

    *Cervical causes – incompetent cervix

    *Infections of the genital tract and other systemic infections 

    *Endocrine causes – such as diabetes

    *Immunologic causes – such as antiphospholipid syndrome 

    *Toxins – such as alcohol, caffeine, high energy radiations, some drugs, etc

    What are the symptoms of abortion? 
    *Vaginal bleeding – from mild spotting to heavy bleeding, can be life-threatening if not treated promptly. 

    *Lower abdominal pain – can be mild to moderate to severe, sometimes no pain 

    *Passage of fetal tissues – clotted blood, fleshy materials, (take note of “vesicles” in case of molar pregnancy) 

    *Gush of fluid from the vagina – ie. amniotic fluid, in second trimester miscarriages 

    *Reduced or NO fetal movement – if the fetal movement has been perceived earlier 

    *Cessation of the usual early pregnancy symptoms 

    *Fever, malaise, vomiting etc – in septic abortion

    Clinical investigations

    -Full history and thorough examination 

    -Complete blood count

    -Blood group – especially Rhesus

    -BHCG levels – to rule out ectopic pregnancy 

    -Pelvic ultrasound 

    -Other investigations to determine the cause, especially in recurrent (>/= 3) pregnancy losses 

    Types of Abortion and their management. 
    *COMPLETE ABORTION – spontaneous expulsion of the foetus and placenta, bleeding stopped and cervix closed. No further management is required except ultrasound to confirm completeness.

    *INCOMPLETE ABORTION – passage of some fetal tissues but not all, cervix is open and bleeding continues. Management – group and prepare blood, IV fluids, medical or surgical evacuation of the remaining uterine contents, +/- blood replacement 

    *THREATENED ABORTION – bleeding but closed cervix. Management – rest and avoid intercourse 

    *INEVITABLE ABORTION – bleeding/rupture of membranes with cervical dilatation but no expulsion of foetus or placenta. Management – expectant, medical or surgical

    *MISSED ABORTION – foetal demise without expulsion, +/- bleeding, cervix closed. Management – medical or surgical. 

    *SEPTIC ABORTION – any abortion associated with uterine infection. Management – IV fluids, antibiotics, followed by surgical evacuation. 


    What are the complications of unsafe abortion or uterine evacuation? 
    If the evacuation is handled by a qualified personnel, using aseptic techniques, the complications are infinitesimally low. 

    Short term complications of unsafe abortion include: 

    *severe blood loss –  which can require blood transfusion and may lead to death if not treated promptly. 

    *infection – septic abortion 

    *uterine perforation 

    *damage to adjacent internal organs such as the bladder and bowels 

    Long term complications include:

    *uterine adhesions

    *menstrual dysfunction 

    *infertility

    IN CONCLUSION 

    -Pregnancy losses more than 3 consecutive times should be thoroughly investigated. A cause can be identified in 50-60% of cases and measures can be taken to prevent subsequent losses. 

    -Patients should be reassured that conception can be achieved within one cycle after complete abortion. The chances of a live birth after 2 or more consecutive miscarriages is up to 50 – 70%

    -A miscarriage can be physically and mentally traumatic. Women should be supported and reassured throughout this trying period.

    WHEN CANCER ATTACKS THE OVARIES

    The ovaries consist of different cell types, performing different functions. Any of these cells can develop into cancer

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    Ovarian cancer is the leading cause of death from gynecological cancers in the UK and USA. It is the 5th most common cause of cancer deaths in women (after lung, breast, colorectal and pancreatic cancers). Up to 20,000 new cases are diagnosed yearly in the US. The peak incidence is in women aged 75 – 84 years, but it can occur in younger women, and even (rarely) in prepubescent girls too.

     

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    CLASSIFICATION 

    The ovaries consist of different cell types, performing different functions. Any of these cells can develop into cancer, but 90% arise from the epithelial (outermost) cells. Ovarian cancers are classified based on the cluster of cells they originate from:

    • Epithelial
    • Sex cord-stromal
    • Germ cells

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    Different subclasses have been described and each has similar features but different growth behavior and response to treatment.

    RISK FACTORS

    Like most cancers, direct causal factors are largely unknown, but various risk factors have been identified:

    • Nulliparity (no previous viable pregnancy)
    • Early menarche (age at onset of menstruation <11 years)
    • Late menopause (age at cessation of menstruation >52 years)
    • Family history of ovarian, breast or colorectal (bowel) cancers
    • Family history of genetic mutations ( BRCA1, BRCA2, and HNPCC)
    • Previous history of ovarian, breast, endometrial and colorectal cancers (treated)

     SCREENING FOR OVARIAN CANCER

    Not routinely done unless one has strong risk factors.

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    SIGNS AND SYMPTOMS

    Ovarian cancer is a great mimicker as it doesn’t show any specific sign until an advanced stage as been reached. Early symptoms are no different from those attributable to other common diseases. These are:

    • Abdominal pain
    • Abdominal distension and bloating
    • Loss of appetite
    • Constipation or diarrhea (or alternation of both)
    • Abnormal menses or vaginal bleeding

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    Late Symptoms include;

     

    • Abdominal/pelvic mass – detected by palpation and confirmed by radiological tests
    • Significant weight loss
    • Difficulty in passing urine
    • Significant abdominal distension (ascites or solid mass)
    • Generalized body swelling (edema or anasarca)
    • Signs of spread to distant organs – uterus and tubes, urinary tract, bowel, stomach, lymph nodes, etc.

     

    INVESTIGATIONS

    After taking a full history and physical examination, specific tests must be done to confirm the diagnosis, determine the extent of the disease and work up for definitive treatment.

    • Full blood count
    • Kidney function test
    • Liver function test
    • Tumor markers – CA125, CEA, CA19.9, etc.
    • Imaging: ultrasound, CT scan, MRI, chest x-ray, etc

     

    MANAGEMENT 

    1. SURGERY: This is both diagnostic and therapeutic. In early stages, the ovaries, uterus, tubes and adjacent lymph nodes will be removed at once. In advanced stages, initial surgery is done to “stage” cancer (to know what stage it is). Subsequent operations may be needed depending on the result of the first surgery and response or recurrence.
    2. CHEMOTHERAPY: The different combination of anti-cancer drugs are available depending on the cell types involved. The platinum-based therapy is given in up to 6 cycles every 3 weeks. Side effects of the drugs include severe vomiting, hair loss, kidney damage, diarrhea etc. These can also be managed and ameliorated.
    3. NOVEL AGENTS: New drugs are being investigated through clinical trials. These include antibodies against cancer-promoting factors in the body (VEGF, EGFR and TKI’s)
    4. SUPPORTIVE TREATMENT: These are palliative measures put in place to alleviate the excruciating pain and suffering associated with advanced ovarian cancer. Such as drainage of ascites, painkillers (strong opioids usually, morphine), emotional support, hospice care, etc.

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    FOLLOW UP IS OFTEN CONTINUED LIFELONG.

    5-year survival rate ranges from 90% to less than 20% depending on the stage of cancer before treatment is commenced.
    PREVENTION 

    It is said that the only way to not have cancer is not to be born. Ovarian cancer can not be predicted 100% but individuals with strong risk factors can be followed closely so as to detect the disease early. They can also opt for prophylactic oophorectomy (removal of the ovaries) after completing their reproductive career (cf. Angelina Jolie). For younger women, eggs can be harvested, frozen and used for IVF when they’re ready to get pregnant later.

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    General healthy lifestyle helps to prevent cancer among other things – healthy diet, regular exercise, quitting alcohol and smoking, etc.

    Childhood Cancers

    To nurse one child in Nigeria with cancer, you need about N2 million on the average in a period of about two years

    By Drs. Azeezah Shopeyin and Ajayi Abass 

    Childhood cancers occur in children less than 15 years. They are devastating not only to the children but their entire family. In Nigeria, it creates a huge financial burden on the family as there is no supportive treatment plan for children and the cost of treatment is very high.

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    Cancer leads to abandonment of treatment and consequently death of children. Hence, prevention of childhood cancers cannot be over emphasized. It’s important to note that in most fields of medicine, pediatrics have been found to be of significant challenge, because of communication challenges, and caregiver support.

    Burden to public health

    The international agency for research on cancer stated in 2004 that worldwide 160,000 children under 15 years get childhood cancers and 90,000 will die from it every year. In 2007, 71.2 of every 1 million Nigerian children below 15 years had childhood cancers.

    Due to the lack of data in Nigeria, and the paucity of studies on childhood cancers, it is not easy to appreciate the burden of childhood cancers, this might be due to the preoccupation with infectious diseases which are said to cause about 25% of childhood deaths.

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    In an 11year retrospective study conducted in northern Nigeria, by A. Mohammed and A.U Aliyu, it was noticed that childhood cancers were 8.44% of cancers diagnosed within that period. A male: female ratio of 1.5:1.

    In 2014, Consultant Paediatrician, Oncology/Haematology Unit of the Lagos University Teaching Hospital, LUTH, Dr. Adebola Akinsulirie, said about four or five cases of childhood cancer are seen monthly at the LUTH. That will give you about 50 children in a year. That is big as far as cancer in children is concerned in Nigeria. To nurse one child with cancer, you need about N2 million on the average in a period of about two years.

    Types of childhood cancers

    The most common childhood cancers accounting for childhood deaths in Lagos  include kidney cancer (nephroblastoma) and blood cancer (Acute lymphoblastic leukemia and Acute myeloid leukemia)

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    Lymphomas (solid cancer of white blood cells) are also quite common childhood malignancies and neuroblastoma (cancer of nerve cells), others include leukemias, bone and muscle tumors.

    Causal or pre-disposing factors

    The cause of most childhood cancers are unknown in about 75-90% of cases, 5-15% are due to familial and genetic factors( intrauterine viral infections, parental occupational/ radiation exposures, war-torn regions and disasters, elderly maternal age above 35, parental especially maternal smoking and alcohol consumption.

     

    and <5-10 % are due to known environmental exposures and exogenous factors (food, radiation, dyes, infections like intrauterine viral infection Epstein-Barr virus and leukemias/ lymphomas etc). It’s important though to note that cancers generally are caused by a variety of factors and are not limited to a single causative agent.

    How to recognize childhood cancers early

    Complaints about any of the following that does not go away in a child:

    • Feeling of an unusual lump or swelling
    • Unexpected paleness and loss of energy
    • Easy Bruising
    • An ongoing pain in one area of the body
    • Limping
    • Unexplained fever or illness that doesn’t go away
    • Frequent headaches, often with vomiting
    • Sudden eye or vision changes
    • Sudden unexplained weight loss

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    Prevention of childhood cancers

    1. Avoidance of chewing or smoking tobacco.
    2. Protection from sunlight.
    3. Limiting fats in diet
    4. A healthy diet with at least 5 portions of fruits and vegetables per day.

    Management of childhood cancers

    Childhood cancers are managed by a team of specialized pediatric cancer care specialists, including pediatric oncologists, pathologists, radiologists, surgeons, radiotherapists, nurses and support staff include the nutritionist, social workers, pharmacists and other medical specialists. First, a correct diagnosis is made; depending on the stage of the disease from Investigations carried out, the child is given drugs,  and surgical intervention or radiation therapy may be necessary.

    infographic_childhoodcancer_large

    The challenges in pediatric cancer are numerous but surmountable if there is the will. These are

    1. Recognition of symptoms by parents
    2. Time of presentation/ late presentation
    3. Lack of funds by caregivers
    4. Limited diagnostic equipment/ facilities
    5. High cost of diagnostic investigations
    6. High cost of treatment
    7. Effects of cytotoxic drugs/radiation therapy
    8. Lack of political standing of their own as such children are forgotten in most policies.

    childhood-hood-cancer-275x366-large-image-web

    The above challenges can be solved if

    1. Adequate awareness is provided about childhood cancers
    2. Children are exclusively included in the NHIS
    3. Funding is provided for research into childhood cancers
    4. Facilities for diagnosis and treatment are provided.
    5. Provision of psychological support and social welfare services.

    In summary

    Childhood cancers are a source of significant burden to the child, parents, and caregivers; as such a lot of support is needed; financial, psychological, and spiritual. The distress from the disease, the financial implications, and stress of accessing treatment including the toxicity of the cytotoxic agents is of significant concern, however, children are more likely to recover from cancers when they are detected early and commenced on therapy as quick as possible.

    childhood-5-year-survival-graph-article

     

     

    Dr. Azeezah Shopeyin graduated from the University of Lagos, college of medicine.With several years experience, she also has a master degree in public health. She’s interested in health education and promotion. She’s a wife and mother of two kids and she enjoys making people happy,

    Dr. Ajayi Abass Oluwaseyi graduated from Ahmadu Bello University in Zaria. Also known as Juggernaut bn Yusuf, he is also a writer, an aspiring Neurosurgeon, and a Farmer. He currently works at the federal teaching hospital in Gombe.